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CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 5  |  Page : 589-590
A case of desmoplastic trichoepithelioma with a new dermoscopy finding


1 Department of Dermatology, Amala Institute of Medical Science, Kerala, India
2 Department of Pathology, Amala Institute of Medical Science, Kerala, India

Date of Web Publication29-Dec-2022

Correspondence Address:
P M Twaseem
Department of Dermatology, Amala Institute of Medical Science, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_1000_21

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How to cite this article:
Twaseem P M, Criton S, Abraham UM, Francis A. A case of desmoplastic trichoepithelioma with a new dermoscopy finding. Indian J Dermatol 2022;67:589-90

How to cite this URL:
Twaseem P M, Criton S, Abraham UM, Francis A. A case of desmoplastic trichoepithelioma with a new dermoscopy finding. Indian J Dermatol [serial online] 2022 [cited 2023 Feb 5];67:589-90. Available from: https://www.e-ijd.org/text.asp?2022/67/5/589/366084




Sir,

A 26-year-old male presented to the outpatient department with skin-coloured papule on his left cheek for 2 years. He was apparently normal 2 years back when he noticed skin-coloured pea-sized papule which was asymptomatic. It progressed in size over the years to about 2 cm in diameter. Furthermore, he also noticed a central depression on the enlarged lesion [Figure 1]. On examination, there was a skin-coloured plaque of size 2 cm diameter with raised beaded edge and central atrophy located 5 cm lateral to alae of the left nose. There was no tenderness or erythema. With the above presentation, a clinical diagnosis of morpheaform basal carcinoma and desmoplastic trichoepithelioma (DT) was kept. A dermoscopic examination using illuco handheld dermoscope (10× magnification) in polarised mode was done, which showed erythematous background with white dots surrounded by milia like cyst [Figure 2]. Furthermore, histopathological examination showed unremarkable epidermis and dermis showing narrow strands of tumour cells, horn cyst of varying sizes some with intraluminal calcification and desmoplastic stroma [Figure 3]. Thus, the diagnosis of DT was confirmed. Subsequently, resection of the lesion was done and the specimen showed the same histopathological findings with an uninvolved margin.
Figure 1: Skin-coloured plaque of size 2 cm diameter with raised beaded edge and central atrophy

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Figure 2: Erythematous background (black arrow) with white dots (orange arrow) surrounded by milia like cyst (blue arrow) (illuco handheld dermoscope, polarised mode, 10× magnification)

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Figure 3: Dermis showing narrow strands of tumour cells, horn cyst of varying sizes some with intraluminal calcification and a desmoplastic stroma (H and E staining, 10× magnification)

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DT is a benign adnexal tumour consisting of cells of follicular germinative differentiation.[1] It was first described as solitary trichoepithelioma by Zeligman in 1960.[2] Later in 1977, Shapiro and Bowenstein coined the term DT.[3] Being a very rare tumour, it accounts for only 1% of all the cutaneous tumours and the overall incidence is about 1 in 5000 skin biopsies.[4] It most commonly presents as skin coloured to an erythematous annular plaque with central atrophy on cheeks of young females similar to the case described above. However, morpheafom basal cell carcinoma (bcc) might have a similar presentation and thus making it clinically indistinguishable. DT has an excellent prognosis in contrast to its clinico-histopathological mimicker – “morpheaform bcc”, which has a very poor prognosis and hence requires vigorous treatment. This makes making an accurate diagnosis imperative.

Dermoscopic features of morpheaform bcc are arborizing telangiectasia, focal shiny white areas, leaf like structures, ovoid nest and chrysalis structures, whereas the presence of ivory white colour background, telangiectasia, keratin cyst and chrysalis structures are pathognomonic of DT.[5] However, in the case described above, the dermoscopic features were not aligned with the classical description of DT or morpheaform bcc, rather it showed a uniform erythematous background with white dots without telangiectasia surrounded by white cystic structures. This made the diagnosis difficult.

Subsequently, a histopathological examination was done, which showed unremarkable epidermis and dermis showing narrow strands of tumour cells, horn cyst of varying sizes some with intraluminal calcification and a desmoplastic stroma. Thus, the diagnosis of DT was confirmed.

Here, we want to emphasise not all cases present with the pathognomic ivory white background and telangectasia. Apart from the already described features, we would like to add the new dermoscopy finding of erythematous background with white dots. Correlating with the histopathology, the authors would like to suggest that this new dermoscopy finding points to an early phase of progressing desmoplastic stroma in skin of colour.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Timothy B, McCalmont H, Pincus LB. Adnexal neoplasms. In: Bolognia JL, Schaffer JV, Cerroni L, editors. Text of Dermatology. 4th ed. China: The Elsevier; 2018. p. 502.  Back to cited text no. 1
    
2.
Zeligman I. Solitary trichoepithelioma. AMA Arch Derm 1960;82:35-40.  Back to cited text no. 2
    
3.
Brownstein MH, Shapiro L. Desmoplastic trichoepithelioma. Cancer 1977;40:2979-86.  Back to cited text no. 3
    
4.
Brownstein MH, Starink TM. Desmoplastic trichoepithelioma and intradermal nevus: A combined malformation. J Am Acad Dermatol 1987;17:489-92.  Back to cited text no. 4
    
5.
Khelifa E, Masouyé I, Kaya G, Le Gal F-A. Dermoscopy of desmoplastic trichoepithelioma reveals other criteria to distinguish it from basal cell carcinoma. Dermatology 2013;226:101-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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