Trichoepithelioma Treatment & Management

Updated: Sep 25, 2018
  • Author: Victor G Prieto, MD, PhD; Chief Editor: William D James, MD  more...
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Treatment

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. [33] Other studies suggest the possibility of targeted therapies, such as antitumor necrosis factor-alpha [34] or targeting mammalian target of rapamycin (mTOR) and hypoxia signaling pathways. [35]

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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. [36, 37, 38]

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.

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Complications

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

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Prevention

No preventive measures for trichoepithelioma are known.

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