Trichilemmoma Treatment & Management

Updated: Mar 08, 2019
  • Author: William P Baugh, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Approach Considerations

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. Even though most tumors are benign, they always should be continually monitored, as malignant transformation has occurred. [17] Trichilemmoma may commonly vary in size, and it should be reevaluated should continual growth occur. [25]

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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. [31]

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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