Clinical Images  |   September 2020
Author Notes
  • From the Mayo Clinic Health System in Albert Lea, Minnesota (Dr Skorin) and the Naval Health Clinic in Quantico, Virginia (Dr Bauer). 
  • Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Department of the United States Air Force, the Department of Defense, or the US Government. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Leonid Skorin Jr. DO, OD, MS, Mayo Clinic Health System, 404 West Fountain Street, Albert Lea, MN 56007-2437. Email:
Article Information
Imaging / Pain Management/Palliative Care / Clinical Images / Headache
Clinical Images   |   September 2020
The Journal of the American Osteopathic Association, September 2020, Vol. 120, 623. doi:
The Journal of the American Osteopathic Association, September 2020, Vol. 120, 623. doi:
A 76-year-old woman presented with a recent-onset growth on her face. Her medical history was negative for skin cancer. Physical examination identified an elevated, indurated, nontender lesion located above the nasolabial fold and below the lower eyelid (image A, arrow). An excisional biopsy was performed. Histological diagnosis was trichoepithelioma which showed branching nests of basaloid cells (image B, red arrow), horn cysts, and abortive hair follicles (image B, black arrow). 
Trichoepitheliomas are uncommon benign hair follicle tumors that are mostly seen in women after puberty. These facial tumors may present as isolated or multiple, firm round lesions and may quickly increase in size.1 Because of their appearance and potential for rapid growth, isolated trichoepitheliomas are often excised and sent for pathologic study. They often appear clinically and histologically similar to basal cell carcinoma.2,3 An isolated lesion may be permanently removed through excision. Multiple lesions, such as those associated with Brooke-Spiegler syndrome, can be treated by electrodesiccation, skin transplantation, laser therapy, or topical 5% imiquimod cream.2 
Karimzadeh I, Namazi M, Karimzadeh A. Trichoepithelioma: a comprehensive review. Acta Dermatovenerol Croat. 2018;26:162-165. [PubMed]
Mohammadi AA, Seyed Jafari SM. Trichoepithelioma: a rare but crucial dermatologic issue. World J Plast Surg. 2014;3(2):142-145. [PubMed]
Salhi A, Bornholdt D, Oeffner F, et al. Multiple familial trichoepithelioma caused by mutations in the cylindromatosis tumor suppressor gene. Cancer Res. 2004;64(15):5113-5117. doi: 10.1158/0008-5472.CAN-04-0307 [CrossRef] [PubMed]