Basal Cell Carcinoma Developing from Trichoepithelioma: Review of Three Cases

Abstract

A 75-year-old female, with a swelling over the right side of the forehead for the last 9 years. It has been growing rapidly for the last three months, extended to right eye brow and upper eyelid producing partial ptosis of right upper eye lid. On examination there was a single skin coloured erythematous plaque studded with papules & nodules of varying size with central atrophy, soft to firm in consistency with ulceration and edge showed beading and pigmentation. Swelling was not fixed to the underlying bone except at the eye brow region. Loss of hair over the lateral aspect of eye brow on right side was noted [ Trichoepitheliomas (TE) are benign tumours but occasionally can undergo transformation to malignant neoplasms more commonly as Basal Cell Carcinoma (BCC). The correct diagnosis between these tumours is very important because basal cell carcinoma is locally aggressive neoplasm and requires total surgical excision with wide healthy margins while trichoepithelioma needs simple excision. We describe three patients who developed basal cell carcinoma with facial trichoepitheliomas. The only clinical feature that distinguished the carcinomas from the trichoepitheliomas was their larger size, in all three patients, one patient with recurrent, hyper pigmented swelling with surface ulceration and in another patient there are multiple trichoepitheliomas, and other family members are also affected. The history, clinical features and histopathological findings were suggestive of the evolution of basal cell carcinoma directly from trichoepithelioma in our first two cases, but in the third case TE and BCC were separate lesions on face and we are uncertain about whether the BCC developed independently or by transformation from a trichoepithelioma. Based on our clinicopathological observations in the three patients and reports in the recent literature, BCC with follicular differentiation and trichoepithelioma are considered to be highly related.was normal. There was no enlargement of regional lymph nodes. No other similar swellings elsewhere over the body.CT scan findings showed a well-defined round mixed density lesion measuring 3x2.6 cm with fluid level noted in supero-lateral aspect of right orbit causing minimal compression, displacement of right eye ball inferomedially and mild erosion of adjacent right frontal bone.Complete excision and repair of the defect was done by temporalis fascia and split skin grafting. Operative findings showed tumour involving the right forehead, extending into the orbit displacing the eye ball inferomedially. Histopathology revealed Solitary giant trichoepithelioma transformed into a Basal cell carcinoma c]. Follow up after 3 weeks showed good healing and the patient is quite comfortable [Table/ Fig-1d]. She is doing well without any recurrence after 1 year as per telephonic follow up. Case 2A 56-year-old female was referred to plastic surgery consultation, she was having multiple, asymptomatic skin lesions over the face since she was 10-year-old. The lesions were more predominant over th...

Multiple Familial Trichoepithelioma

“…Figure 2 -Trichoepithelioma: multiple nodular proliferations of uniform basaloid cells with focal peripheral palisading and small keratin-filled cysts (H&E, 40x) exon 9 of CYLD gene [c.1112C > A(p.Ser371*)], supporting the diagnosis of multiple familial trichoepithelioma (MFT).MFT is an uncommon autosomal-dominant genodermatosis characterized by multiple TE on the face, scalp and, neck with rare reports on other anatomical locations 1. The association of MFT with malignancy is rare, however, TE can infrequently undergo malignant transformation to BCC [2][3][4]. That is why these patients should be kept under long-term observation.…”

“…1 The association of MFT with malignancy is rare, however, TE can infrequently undergo malignant transformation to BCC. [2][3][4] That is why these patients should be kept under long-term observation. A 62-year-old woman presented with multiple skin--coloured papules and nodules on the scalp, face and intergluteal cleft which had developed slowly since childhood (Fig.…”