A Case of Trichilemmal Carcinoma Treated with Mohs Micrographic Surgery

Abstract

Trichilemmal carcinoma is a cutaneous adnexal tumor originating from the outer root sheath of hair follicle, and it was first described by Headington in 1976. Clinically, it usually occurs as an asymptomatic solitary papule, nodule or mass on the face or scalp. This neoplasm is a malignant counterpart of trichilemmoma, and it has been reported in the literature as trichilemmal carcinoma, tricholemmal carcinoma, malignant trichilemmoma, and tricholemmocarcinoma. Although histologically, trichilemmal carcinoma frequently has maliganant features, it has a relatively benign clinical behavior. We think Mohs micrographic surgery is a useful treatment modality in trichilemmal carcinoma because the final skin defect is smaller than a wide excision. We report a case of primary trichilemmal carcinoma which had developed on the face, treated with Mohs micrographic surgery. The lesion enlarged slowly with bleeding tendency on the surface (Fig. 1). He had a past history of liver cirrhosis with elevated liver enzymes and serologic markers of hepatitis B virus infection. Abdomen computerized tomography and ultrasonograghy showed hepatosplenomegaly without any evidence of regional lymph node metastasis. We could not find any abnormal findings on the head and neck computerized tomography either.An incisional biopsy was done under the impression of squamous cell carcinoma. Histopathologically, we could observe a relatively well-circumscribed tumor, which was connected with the

Locally aggressive trichilemmal carcinoma

“… 1 TC may also develop on seborrheic keratosis, nevus sebaceous, discoid lupus scarring and tuberculosis verrucosa cutis. 1 , 3 , 7 , 8 …”

“…Some authors suggest that safety margins greater than 1 cm are associated with increased overall survival. 1 , 4 , 5 , 8 , 9 Nonetheless, safety margins of 1 cm have been used safely and cost-effectively. 4 However, over the past decade, Mohs micrographic surgery has been shown to have higher recurrence-free rates, becoming the gold standard treatment to preserve the surrounding healthy tissue.…”

Metastatic trichilemmal carcinoma in a patient with breast cancer

“…Zhuang et al 16 showed improved overall survival in their study when a surgical margin of 1 cm was taken. Mohs micrographic surgery could also be used for excision of TC, as it allows for immediate assessment of surgical margins while preserving as much normal tissue as possible; Kim et al 17 reported no recurrence in 19 months of follow-up when using Mohs micrographic surgery for excision of TC.…”

Recurrent trichilemmal carcinoma of the periorbital region treated with IMRT radiotherapy: A case report and a review of literature

“…[ 4 ] The treatment recommended in the literature is exclusively surgery or micrographic Mohs surgery (MMS) with enough tumor-free margin. [ 5 , 6 ] We report a case of a patient with recurrent TLC of the periorbital region after surgery treated with radiotherapy.…”