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Trichoepithelioma Treatment & Management

  • Author: Victor G Prieto, MD, PhD; Chief Editor: William D James, MD  more...
Updated: May 19, 2016

Approach Considerations

Treatment of the trichoepithelioma lesion is primarily surgical. Laser and radiofrequency have been used with diverse results. A Brazilian study of several types of cutaneous tumors reported only a partial response for trichoepithelioma to 5% imiquimod cream.[34] Other studies suggest the possibility of targeted therapies, such as antitumor necrosis factor-alpha[35] or targeting mammalian target of rapamycin (mTOR) and hypoxia signaling pathways.[36]


Surgical Care

Solitary lesions can be excised. In the case of multiple tumors, this surgical approach may not be feasible.

Split-thickness skin grafting, dermabrasion, and laser surgery have been proposed, but the results of these procedures vary.[37, 38, 39]

Management of either form (ie, solitary, multiple/hereditary) by superficial biopsy is usually adequate.

Recurrence of solitary trichoepithelioma is uncommon. When the multiple facial lesions are surgically flattened by dermabrasion or laser therapy, they tend to regrow into elevated papules or nodules. This regrowth may occur rapidly within months, or it may take several years. Some patients find a prolonged cosmetic improvement to be worthwhile even if repeated procedures are necessary.

Ensure that the patient is informed about the possibility of scarring. As with many benign skin neoplasms, the patient is mainly concerned about the aesthetic appearance of the lesion. Scarring may result from all available methods for tumor removal. In patients with multiple lesions, treating 1 or 2 of the lesions and showing the patient the final result may be helpful before embarking on extensive aggressive therapy.



The persistence or recurrence of trichoepitheliomas is a complication, and scarring may occur after treatment.



No preventive measures for trichoepithelioma are known.

Contributor Information and Disclosures

Victor G Prieto, MD, PhD Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center

Victor G Prieto, MD, PhD is a member of the following medical societies: American Society of Dermatopathology, College of American Pathologists, American Association for the Advancement of Science, International Society of Dermatopathology, European Society of Pathology, American Medical Association, American Society for Clinical Pathology, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.


Christopher R Shea, MD Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago, The Pritzker School of Medicine

Christopher R Shea, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology, Association of Professors of Dermatology, International Society of Dermatopathology, Arthur Purdy Stout Society, Chicago Dermatological Society, Dermatology Foundation, Illinois Dermatological Society

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.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

Warren R Heymann, 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

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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Characteristic clinical morphologic features. Notice the numerous, small papules, predominantly close to the midline.
Well-circumscribed, superficial lesion composed of clusters of basaloid cells within a fibrous stroma. This arrangement of epithelial cells and stroma is described as organoid.
The cystic spaces contain keratin. Notice the lack of mitotic figures or apoptotic bodies.
Papillary-mesenchymal bodies are structures associated with hair follicle differentiation. They are characterized by an aggregate of spindle, stromal cells, closely apposed to a hair bulb (arrow; darkly staining, basaloid epithelial cells).
Because trichoepitheliomas recapitulate follicular differentiation, they may contain cells commonly seen in hair follicles such as melanocytes. This image illustrates both melanocytes (black arrow) and dermal melanophages (white arrow).
Immunohistochemical studies detect expression of CD34 by many of the dendritic cells that surround the tumor aggregates (anti-CD34, diaminobenzidine, and hematoxylin).
Desmoplastic variant. Notice that many of the aggregates of basaloid cells are small, resembling a syringoma; however, they contain keratin instead of eccrine secretion. Also notice the characteristic markedly fibrous stroma.
High-powered view of desmoplastic trichoepithelioma. Notice the cluster of squamous cells surrounding a small cystic area containing keratin. Intervening stroma is markedly fibrous.
The malignant counterpart, trichilemmal carcinoma, typically shows areas with infiltrative growth and necrosis.
Trichilemmal carcinoma cells have large, lightly stained cytoplasm with large, pleomorphic nuclei. As a sign of follicular differentiation, some cells may display the characteristic cytoplasmic, red, trichohyalin granules (arrows).
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