Trichoepithelioma 100 Years Later: A Case Report Supporting the Use of Radiotherapy

Abstract

Trichoepitheliomas are rare skin tumors which can cause significant cosmetic and functional impairment when they occur in the head and neck area. Multiple methods of treatment including plastic surgery, dermabrasion, cryosurgery and laser surgery have been reported in the literature. A 32-year-old male with multiple coalesced lesions in his ear canals was treated with radiation therapy after he failed more conventional methods of treatment. He is free of tumor in the radiated area 17.5 months after treatment with significant functional improvement. Various aspects of this tumor were reviewed. More data are still needed to define the proper place for radiation in the management of this disease.

Treatment of Multiple Trichoepitheliomas with Topical Imiquimod and Tretinoin

“…Treatment of multiple trichoepitheliomas include cryotherapy, electrodessication, radiation, dermabrasion, oral retinoids, surgical excision, electrosurgery, pulse dye laser, CO 2 laser, and argon laser (4–10). Complications associated with these treatment methods include scarring, the need to inject local anesthetic, pain, bleeding, and increased risk of skin cancer because of radiation exposure.…”

Treatment of Multiple Trichoepithelioma with Electrosurgery

“…Primary excision for multiple lesions is not practical. Dermabrasion, electrodessication and curettage, radiotherapy, and laser treatment all offer temporary measures to decrease tumor bulk and improve appearance 7,10,11,12 . They all have disadvantages.…”

“…The nose, forehead, and upper lips may be involved with occasional extension to the scalp, neck, and trunk 3 . Rarely they have caused visual and auditory impairment secondary to involvement of the periobital region and external auditory canal respectively 5,7 …”

“…The carbon dioxide and argon lasers have been used successfully with disease‐free intervals of greater than 15 months posttreatment 11,12 . In addition, radiotherapy has been used to treat lesions in the ear canal of one patient with a tumor‐free period of 17.5 months posttreatment 7 . It should be noted that due to the invasive nature of desmoplastic trichoepithelioma they are preferably treated with Mohs micrographic excision.…”

Brooke-Spiegler Syndrome: treatment with laser ablation.

“…Treatment methods for adnexal tumours reported in the literature include excision, dermabrasion, electrodessication, cryotherapy and radiotherapy 14–18 . Treatment using CO 2 laser alone and argon laser have also been reported 19–21 .…”