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A 35-year-old man is referred for evaluation of a growth on his right cheek. His primary care physician thought it looked suspicious for basal cell carcinoma. The lesion has been present for at least 1 year and is asymptomatic, although the patient is often bothered by a hair that arises from the base. Examination reveals a flesh-colored papule with a central, white hair. No similar lesions are noted elsewhere.
Can you diagnose this condition?
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Trichofolliculoma is an uncommon malformation of the pilosebaceous unit. Lesions are benign; however, differential diagnosis often includes basal cell carcinoma similar to other hair follicle neoplasms.1,2 Trichofolliculomas usually develop spontaneously on the face — most frequently around the nose — as small, solitary, dome-shaped, flesh-colored or white papules ranging in diameter from 0.2 to 1.0 cm. A central pore may drain sebaceous-like material. A tuft of fine, white, wool-like hairs is characteristic of trichofolliculomas. Microscopic examination reveals numerous vellus hair follicles embedded in connective tissue.3
Trichofolliculomas do not require therapy, and treatment is usually for cosmetic reasons. Complete local excision is curative, and malignant transformation is rare.4
Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
References
1. Carr RA, Sanders DSA. Basaloid skin tumors: mimics of basal cell carcinoma. Curr Diagn Pathol. 2007;13(4):273–300.
2. Ghosh SK, Bandyopadhyay D, Barma KD. Perifollicular nodule on the face of a young man. Indian J Dermatol Venereol Leprol. 2011;77(4):531-533.
3. Misago N, Kimura T, Toda S, Mori T, Narisawa Y. A revaluation of trichofolliculoma: the histopathological and immunohistochemical features. Am J Dermatopathol. 2010;32(1):35–43.
4. Stern JB, Stout DA. Trichofolliculoma showing perineural invasion. Trichofolliculocarcinoma? Arch Dermatol. 1979;115(8):1003-1004.
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