Wednesday, June 03, 2009


A Dermatologic Vignette.

The patient is a 78 yo woman with a few year history of an enlarging lesion on the nasal tip. Excellent health.

Eight mm in diameter pearly papule nasal tip. Clinically and dermoscopically BCC.

Pathology shows this to be a trichoeoithelioma:

Question: Observe, refer to Mohs, radiate?
Would surgery be deforming in this site? vs. Is radiotherapy overkill?

Reference: There are very few references which address this type of lesion, unless we consider this to be like a BCC. But here is one.

Aygun C, Blum JE. Trichoepithelioma 100 years later: a case report supporting the use of radiotherapy. Dermatology. 1993;187(3):209-12.
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.

Remember Dorinda and Walter Shelley's poem:
Who knows
Who's nose
Needs Mohs


  1. AnonymousJune 03, 2009

    Thanks alote:Interesting case.Shave and simple cautry
    khalifa sharquie

  2. Ashok Kumar SharmaJune 04, 2009

    Shave excision and/or controlled cryotherapy appear to be safe practical options.

  3. Michael Albom, M.D.June 25, 2009

    The history is important in that the lesion is enlarging. Remember, a biopsy is a sampling of tissue. Another biopsy 2 mm away from the present biopsy site might reveal BCC. I have seen this situation in two cases. Microscopic patterns of neoplasms do not always correlate with the biologic action of the neoplasms.

    Even if all biopsies reveal only trichoepithelioma, what does the clinician do? Radiation therapy is a possibility but there is little information about long-term results (more than 5 years post-op). Many would consider Mohs surgery to be overkill, but if the lesion continues to enlarge, it is biologically aggressive and needs to be extirpated. With modern plastic surgical techniques, reconstructive surgical results after Mohs are often quite good.

  4. I am 20 yrs old and have trichoepithelioma. They are mostly around the nose and forehead. My parents and I have been trying for year to find a treatment in our country Jamaica but was unsuccessful. Please assist me with the best place I can visit to treat it so I can live a normal life.

  5. To Anonymous from Jamaica. I can help you find a dermatologist who can treat your trichoepithelimas -- but will need your email address so I can let you know. DJ Elpern VGRD organizer.

  6. I have it, too. I have it since I was 2 years old and now I'm 25 ...I really wanted to go to the dermatologist coz it's spreading all over my face.We also have dermatologist here.But I'm afraid that if the dermatologist will fail to treat will lead to cancer..Can it lead to cancer?

    1. AnonymousJune 13, 2012

      I was told it was possible to be pre cancerous but highly unlikely. I had a plastic surgeon remove a lot of it and have not had any problems. Go for it.

  7. I have had trichopithiloma for the last 22 years. A year ago I had a biopsy & was diagnosed. Mine is not hereditary. No dermatologist wanted to mess with it. I finally have one that is shaving them off I'm on my 3rd shave because they are all over my face & ears but since I've been having them shaved I have acquired really bad headaches & allergy/sinus problems. Does anyone know if that causes all these problems? If you know anything or can suggest something please email me thank you.

  8. AnonymousJune 13, 2012

    I am 31 years old and have had it beginning about 14 years old and progressively getting worse by age especially in my early 20's. I located a plastic surgeon who identified it and about 6-7 outpatient procedures later I have had a good amount of the problem areas removed. A couple of more problem areas have developed, that are just the nodules which have increased in size a little bit over time, that I think I will have to go get removed like last time. I had my lesions excised not shaved. I haven't seen a real resurgence and would recommend the surgery. Its not too painful except when you actually get the shots to numb the area before its cut out. I use and would recommend using skin care products like mud masks, daily face wash, and some type of face scrub, it seems to help the look of the skin.

  9. I too have multiple trichoepithelioma since I was eight years in my 40s. I wish I had the answers for a complete cure. I had laser surgery done. It was pretty sucessful, however, I have some scarring from it. I have been searching and searching for anything that would be the answer. I recently have inquired about stem cell treatments. VERY EXPENSIVE. And of course insurance won't pay for it. To date (that I can find)there has not been anyone with multiple trichoepithelioma who has had it done to see if it works or not. And trying to get any research hospital, lab, school, or other research insitutes to even think about looking into it also takes $$ and lots of it. If I EVER find anything out I will share with you we are in this together. If anyone would like to share the names of their doctors that would be helpful!


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