Abstract
Currently, all lesions diagnosed clinically as basal cell carcinoma (BCC) are treated by the excision of the lesion with 3–4 mm margins followed by histopathological examination to assess clearance and confirm the diagnosis. We present the findings of surgical incisional and excisional biopsy of three young patients diagnosed on clinical examination as having BCC, who were found on histological examination to have trichoepithelioma. Whilst it may be possible to distinguish the features of trichoepithelioma in incisional biopsy specimens on morphological grounds alone it is often difficult, and immunohistochemical staining, to delineate the features of the basement membrane, provides useful additional information in the histological diagnosis. As trichoepithelioma is more common in the young it should be considered in the differential diagnosis in young patients presenting with BCC-like lesions of the periocular tissues. This subgroup of patients should have incisional biopsy carried out, and if the diagnosis of trichoepithelioma is confirmed the lesion may be excised with a small margin of healthy tissue, thereby facilitating surgical repair.
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Wolf DJ, Zitelli JA . Surgical margins for basal cell carcinoma. Arch Dermatol 1987;123:340–4.
Simpson W, Garner A, Collin JR . Benign hair-follicle derived tumours in the differential diagnosis of basal cell carcinoma of the eye-lids: a clinicopathological comparison. Br J Ophthalmol 1989;73:347–53.
Flores JT, Apfelberg DB, Maser MR, Lash H . Trichoepithelioma: successful treatment with argon laser. Plast Reconstr Surg 1984;74:694–8.
Duhra P, Paul JC . Cryotherapy for multiple trichoepithelioma. J Dermatol Surg Oncol 1988;14:1413–5.
DeVita VT, Hellman S, Rosenberg SA . Cancer: principles and practice of oncology. 4th ed. Philadelphia: JB Lippincott, 1993.
Lever WF, Schaunburg-Lever G . Tumours of the epidermal appendages. In: Histopathology of the skin. 7th ed. Philadelphia: JB Lippincott, 1990:578–650.
Gaul LE . Heredity of multiple benign cystic epithelioma. Arch Dermatol Syph 1953;68:517–24.
Zeligman I . Solitary trichoepithelioma. Arch Dermatol 1960;82:35–40.
Takei Y, Fukushiro S, Ackerman AB . Criteria for histologic differentiation of desmoplastic trichoepithelioma (sclerosing epithelial hamartoma) from morphea-like basal cell carcinoma. Am J Dermatopathol 1985;7:207–21.
Brownstein MH, Shapiro L . Desmoplastic trichoepithelioma. Cancer 1977;40:2979–86.
Boring CC, Squires TS, Tong T . Cancer statistics. Cancer 1992;42:19–38.
Lober CW, Fenske NA . Basal cell, squamous cell and sebaceous gland carcinomas of the periorbital region. J Am Acad Dermatol 1991;25:685–90.
Brooke JD, Fitzpatrick JE, Golitz LE . Papillary mesenchymal bodies: a histologic finding useful in differentiating trichoepitheliomas from basal cell carcinomas. J Am Acad Dermatol 1989;21:523–8.
Koboyasi T . Dermo-epidermal junction in basal cell carcinoma. Acta Derm Venereol 1970;50:40.
Hashimoto K, Yamahashi Y, Dabbous MK . Electron microscope observations in vivo and in vitro: collagenolytic activity of the basal cell epithelioma of the skin. Cancer Res 1972;32:2561.
Weber L, Krieg T, Muller PK, Kivsch E, Timpl R . Immunofluorescence localisation of type IV collagen and laminin in human skin and its application in junction zone pathology. Br J Dermatol 1982;106:267.
Kimura S, Yamasaki Y, Nishikawa S, Hotano H . A comparative study of seborrhoeic keratoses and basal cell epitheliomas by complement immunofluorescence and electron microscopy. Acta Derm Venereol 1980;60:203.
Kirchmann TT, Prieto VG, Smoller BR . CD34 staining pattern distinguishes basal cell carcinoma from trichoepithelioma. Arch Dermatol 1994;130:589–92.
Smoller BR, van de Rijn M, Lebrun D, Warnke RA . bcl-2 expression reliably distinguishes trichoepitheliomas from basal cell carcinomas. Br J Dermatol 1994;131:28–31.
Swanson NA . Moh's surgery: technique, indications, applications and the future. Arch Dermatol 1983;119:761–73.
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Votruba, M., Collins, C. & Harrad, R. The management of solitary trichoepithelioma versus basal cell carcinoma. Eye 12, 43–46 (1998). https://doi.org/10.1038/eye.1998.7
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DOI: https://doi.org/10.1038/eye.1998.7