A Rare Case of Trichilemmal Carcinoma: Histology and Management

Lisa Fronek; Allyson Brahs; Maheera Farsi; Richard Miller

A Rare Case of Trichilemmal Carcinoma: Histology and Management

J Clin Aesthet Dermatol. 2021 Jun;14(6):25-30. Epub 2021 Jun 1.

Authors

Lisa Fronek^{1

2}, Allyson Brahs^{1

2}, Maheera Farsi^{1

2}, Richard Miller^{1

2}

Affiliations

¹ Drs. Fronek, Brahs, and Miller are with HCA Healthcare USF Morsani College of Medicine Largo Medical Center Program in Largo, Florida.
² Dr. Farsi is with the Department of Mohs Micrographic Surgery at the University of Florida in Gainesville, Florida.

PMID: 34804352
PMCID: PMC8594537

Abstract

Trichilemmal carcinoma (TC) is a rare cutaneous tumor thought to be derived from the follicular outer root sheath (ORS). It often manifests as a nondescript skin-colored or pink papule on the hair-bearing, sun-exposed anatomic sites of elderly patients. Trichilemmal carcinoma shows many histologic features reminiscent of follicular ORS-notably, its glycogen-rich clear cells, trichilemmal keratinization, and similar immunostaining profile. Historically, it has been described as following a relatively indolent clinical course, but cases of recurrence, local aggression, and distant metastases have recently been elucidated. Here, we report the case of a 66-year-old male patient who presented with an asymptomatic, erythematous plaque on his neck; biopsy confirmed a diagnosis of TC. The patient deferred Mohs micrographic surgery in favor of wide local excision and was treated successfully with 3-mm margins. Salient histopathologic features, treatment modalities, and management recommendations are discussed.

Keywords: Trichilemmal carcinoma; adnexal tumor; clear cell; outer root sheath; trichilemmal keratinization.

Publication types

Case Reports