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Trichilemmoma Treatment & Management

  • Author: William P Baugh, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jul 24, 2014
 

Medical Care

The best medical treatment of a tricholemmoma is to begin by establishing the correct diagnosis. Because these tumors are benign, no medical treatment is required. However, a few treatment options are available, ranging from simple surgical excision to carbon dioxide laser tissue ablation.

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Surgical Care

A standard surgical approach to a patient with a trichilemmoma is to perform a shave biopsy. This procedure provides a tissue specimen for histologic examination and facilitates removal of the epithelial growth. If the shave biopsy is performed flush to the skin surface, it often produces an excellent cosmetic result. However, performing a shave biopsy does not eliminate the possibility of a recurrence.

Excision is an option but is less commonly performed because of the benign nature of this neoplasm and its common location on the face.

Electrodesiccation may be used to remove a trichilemmoma. However, electrodesiccation followed by curettage is not indicated for this benign neoplasm. This procedure produces unnecessary and unsightly scarring.

One report describes successful treatment of desmoplastic trichilemmoma (a variant of trichilemmoma) with Mohs micrographic surgery.[25]

Probably the most elegant procedure to date for removing a trichilemmoma is the use of a carbon dioxide laser for tissue ablation. Carbon dioxide laser has been used for removal of a wide range of epidermal and dermal growths or neoplasms. Under local anesthesia, the hypertrophic and hyperkeratotic epithelium characteristic of a trichilemmoma may be rapidly and precisely vaporized.

The coagulated tissue subsequently may be wiped away. This process is repeated until the tissue is flush with the surrounding skin surface and/or the tumor has been destroyed. The remaining tissue and thermal debris is allowed to heal and usually separates from the epidermis in 3-5 days after the procedure. Reepithelialization is usually complete within 4 weeks.

This procedure is particularly useful if multiple trichilemmomas are present (eg, Cowden syndrome).

The carbon dioxide laser has the following advantages: It allows for precise tissue ablation. Multiple lesions can be treated with ease. The procedure can be performed quickly. Morbidity is minimal. Patient recovery time is relatively short. Cosmetic results are usually excellent.

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Consultations

If the diagnosis of trichilemmoma is established and no other clinical features or family history of Cowden syndrome is found, then no further consultation is needed. However, if the medical provider finds evidence of Cowden syndrome, referral to a dermatologist is needed. Secondary referrals to a gastroenterologist, internist, endocrinologist, and a surgeon may be needed.

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Contributor Information and Disclosures
Author

William P Baugh, MD Assistant Clinical Professor of Dermatology, Western University of Health Sciences; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

David Barnette, Jr, MD Voluntary Associate Clinical Professor, University of California San Diego School of Medicine

David Barnette, Jr, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

James H Kerr, MD Former Head (Retired), Department of Dermatology, Naval Medical Center at San Diego

James H Kerr, MD is a member of the following medical societies: American Academy of Dermatology, Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Walter D Kucaba, DO Private Family Practice, Simpsonville, South Carolina

Walter D Kucaba, DO is a member of the following medical societies: Aerospace Medical Association, American Medical Association, American Osteopathic Association, Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Cynthia L Chen, DO, DO Intern, Pacific Hospital of Long Beach, California

Cynthia L Chen, DO, DO is a member of the following medical societies: American Osteopathic Association, California Medical Association, American Osteopathic College of Dermatology, Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

David P Fivenson, MD Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan

David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Michigan State Medical Society, Society for Investigative Dermatology, Photomedicine Society, Wound Healing Society, Michigan Dermatological Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

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A patient with trichilemmoma papules on the face.
Low-power histologic view of a trichilemmoma.
Mid-power histologic view of a trichilemmoma.
Low-power histologic view of a desmoplastic trichilemmoma.
High-power histologic view of a desmoplastic trichilemmoma.
Tumor of the follicular infundibulum.
Clinical image of the face of a patient with Cowden syndrome.
Clinical image of the oral mucosa of a patient with Cowden syndrome.
Clinical image of palmar keratoses in a patient with Cowden syndrome.
Clinical image of sclerotic fibroma in a patient with Cowden syndrome.
Clinical image of multiple trichilemmomas in a patient with Cowden syndrome.
 
 
 
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