Trichilemmal cysts are common fluid-filled growths that arise from the isthmus of the hair follicle. They can form rapidly multiplying trichilemmal tumors-, also called proliferating trichilemmal cysts, which are typically benign. Rarely, proliferating trichilemmal cysts can become cancerous. Here we report the case of a patient who experienced this series of changes. The 27-year-old male patient had been observed to have a 1×1 cm cyst 7 years ago. Eight months prior to presentation at our institution, incision and drainage was performed at his local clinic. However, the size of the mass had gradually increased. At our clinic, he presented with a 5×4 cm hard mass that had recurred on the posterior side of his neck. The tumor was removed without safety margin, and the skin defect was covered with a split-thickness skin graft. The pathologic diagnosis was a benign proliferating trichilemmal cyst. The mass recurred after 4months, at which point, a wide excision (1.3-cm safety margin) and split-thickness skin graft were performed. The biopsy revealed a trichilemmal carcinoma arising from a proliferating trichilemmal cyst. This clinical experience suggests that clinicians should consider the possibility of malignant changes when diagnosing and treating trichilemmal cysts.

INTRODUCTIONBreast reconstruction involves several steps, culminating in the creation of the nipple-areolar complex. Nonetheless, adequate maintenance of nipple projection remains a problem faced by plastic surgeons. Numerous nipple reconstruction methods have been introduced, and various materials including cartilage [1], bone [2], fat [3], dermal graft [4], and acellular dermal matrix (ADM) [5] have been used to provide stable long-term projection of the reconstructed nipple. However, reconstructed nipples lose their projection over time, leading to late-onset flattening. Losken et al. [6] reported that the loss of initial nipple projection in the C-V flap technique was less than 50% in previous studies. AlloDerm ® (LifeCell Corp., Branchburg, NJ, USA) was first employed for nipple reconstruction in 2005 by Nahabedian [5]. It was rolled and used as a filling material within the pocket made by the lateral wings of the flap. It was reported that the use of AlloDerm ® in nipple reconstruction resulted in improved long-term projection. Subsequently, several reports have been published discussing the positive role of ADM in nipple reconstruction.In this clinical study, we evaluated a new technique in which an ADM (AlloDerm Background Breast reconstruction involves several steps, culminating in the creation of the nipple-areolar complex. Numerous methods of nipple reconstruction have been attempted, and have all proven somewhat successful in providing tissue for projection. In this clinical study, we evaluated a new technique using an acellular dermal matrix (ADM; AlloDerm

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