Eyelid Desmoplastic Trichilemmoma

Abstract

Desmoplastic trichilemmomas (DTs) are a rare variant of trichilemmomas first described in 1985. Since then, 11 cases involving the eyelid have been reported. Two cases of this study raise this total to 13. DTs are often clinically confused with basal cell carcinoma and must be proven by biopsy to obtain the correct diagnosis. These lesions are more commonly present in patients older than 50 years. Despite the fact that they are benign, they are often associated with basal cell carcinomas and as such should be managed carefully, requiring excisional biopsy with frozen borders or Mohs controlled margins.

Desmoplastic trichilemmoma of the scalp: case report and literature review of immunohistochemical staining features

“…DT is regarded as a rare lesion: Tellechea et al 10 identified only seven cases of DT in 21,198 consecutive skin biopsies, and Crowson et al 11 identified only 28 cases of DT among 120,000 accessioned biopsies over 18 months. The disease typically occurs in men at a mean age of 59.5 years (range: 8-89 years), 7 and primarily affects the face (particularly in or around the lips, as well as on the eyelids); 12 it sometimes occurs on the scalp, neck, or chest. 9 DT typically comprises a single dome-shaped papule <1 cm in diameter, which is smooth or crusted; it may exhibit pearly edges.…”

“…DT is a benign adnexal tumor of the outer sheath of the pilosebaceous follicle, which comprises superficial lobular growth with central desmoplastic stroma. This tumor was first described by Hunt et al 9 7 and primarily affects the face (particularly in or around the lips, as well as on the eyelids); 12 it sometimes occurs on the scalp, neck, or chest. 9 DT typically comprises a single dome-shaped papule <1 cm in diameter, which is smooth or crusted; it may exhibit pearly edges.…”

Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Follicular Differentiation

“…Multiple risk factors have been identified, including UV and ionizing radiation, previous trauma or scar, genetic disorders (xeroderma pigmentosum and Cowden disease), and immunosuppression associated with solid organ transplantation. Tumors may also grow secondary to naevus sebaceous or be histologically related to BCC [ 76 , 77 , 78 ]. It has been hypothesized that human papillomavirus (HPV) might have a pathogenetic role.…”

“…Other immunohistochemical stains, such as p16, are also diagnostic [ 75 , 82 , 83 , 84 ]. Desmoplastic trichilemmoma, a histological variant, presents with a pseudocarcinomatous pattern, including a prominent fibrotic or desmoplastic stroma, but without nuclear atypia or mitotic activity [ 78 ].…”

“…Treatment of trichilemmoma is usually surgical excision; however, the recurrence rate after surgery is unknown ( Table 2 ) [ 78 ].…”