View 2019 Abstracts

Trichilemmoma is a benign tumor derived from the outer root sheath of hair follicles. Trichilemmoma can be associated with basal cell carcinoma (BCC), either as a collision lesion or from malignant transformation. This study evaluates malignancy associated with eyelid trichilemmoma & principles of treatment.

Retrospective study involving biopsy-proven eyelid skin trichilemmoma cases over 15 years encountered at Sheffield Teaching Hospitals NHS Foundation Trust. Presenting features, differential diagnosis, type and number of operations required, and histopathological features were analysed.

We identified 36 cases with an average age of 66 years. The majority of patients presented with either enlarging (44%) or persistent (31%) lumps. The clinical differential diagnoses were mainly BCC (44%), squamous cell carcinoma (SCC) (3%) & papilloma (36%). 3/36 patients (8%) had trichilemmoma with associated BCC. Of the 19/36 cases (53%) of trichilemmomas without BCC with equivocal surgical margins, 7/36 patients (19%) opted for further excision while 12/36 patients (33%) opted for observation & were discharged. One patient re-presented 2 years later with invasive BCC.

Trichilemmoma can mimic malignant skin conditions, therefore a biopsy or excision should be performed. Patients should be informed that a small proportion of incompletely excised trichilemmomas may conceal underlying malignancy. Therefore, further surgery to achieve clear surgical margins should be offered. Patients who opt for observation must be advised to report any recurrence of lumps or skin changes at the site of previous lesion.