Desmoplastic trichoepithelioma - large case series, clinicopathology and management review



Desmoplastic trichoepithelioma (DTE) is a benign adnexal tumor that typically presents as a small, slow-growing annular papule or plaque on the face. There is a predilection for females, and young to middle aged adults. Examination reveals an asymptomatic annular or oblong, skin-coloured (white, white-grey or yellowish), firm plaque or nodule with a depressed non-ulcerated centre and raised, rolled edge in many cases. They typically vary from 3 to 10 mm in diameter. Familial cases have been reported. Clinically, the differential diagnosis includes basal cell carcinoma (BCC), sebaceous hyperplasia, conventional trichoepithelioma, syringoma, microcystic adnexal carcinoma, and granuloma annulare. Histologically, DTEs may resemble morpheaform BCC, trichoepithelioma, syringoma, microcystic adnexal carcinoma, and trichoadenoma. Because DTEs can be clinically and histologically misdiagnosed as a malignancy, there is debate surrounding the treatment of choice. Current treatment options include watchful waiting (if confident of histological diagnosis after biopsy), and excision. Other treatments reported include dermabrasion, laser surgery, and Mohs micrographic surgery (MMS). The treatment methods of DTE will be reviewed. The aim of this study is to present the largest case series (27 cases) in the modern era of patients with biopsy confirmed DTE. Clinicopathological aspects including histopathological features and immunohistochemistry are analysed regarding how best to avoid misdiagnosis. An important finding in this cohort was a small percentage developed BCC in or near the DTE.


Dr. Tristan Blake

I'm a 2nd year Dermatology registrar based in Brisbane, Australia.