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Trichilemmal cyst on the cheek with sebaceous hyperplasia-like features
Imane Couissi, Zakia Douhi, Zineb Fajri, Meryem Soughi, Sara El Loudi, Hanane BayBay, Fatima Zahra Mernissi
Department of Dermatology, University Hospital Hassan II, Fès, Morocco
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© Our Dermatology Online 2025. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.
Sir,
The trichilemmal cyst (TC) is a common benign adnexal skin tumor that occurs in hairy places, usually on the scalp, rarely on the extremities (1.4%) [1]. Clinically, it presents as smooth nodules on the scalp in elderly men and women.
Malignant transformation is extremely rare. It may be sporadic or show autosomal dominant inheritance.
Some unusual localizations of TCs have been reported, such as the fingers, upper lip, vulva, nose, pubis, buttock, wrist, chest, and elbow. One report describes a TC in the neck region.
There has only been one dermoscopic description of a TC, found by Gencoglan et al. on the arm, describing a diffuse, homogeneous, blue pigmentation with a minimal reddish hue. These features were due to dense, homogeneous keratin materials and the Tyndall effect [2].
Dermoscopic aspects, however, may vary according to the anatomical location and depth of the tumor. The dermoscopic features of sebaceous hyperplasia show a pattern composed of aggregated, yellowish-white structures in the center of the lesions with a surrounding crown of vessels in most cases, yet arborizing vessels seen in 16.7% of cases according to Argenziano et al. [3].
Herein, we report a 27-year-old female who consulted for a nodule located on the right cheek and evolving for one year. A dermatological examination found a round, well-limited nodule, 1 cm in size, with regular, skin-colored contours located on the right cheek (Fig. 1a).
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Figure 1: (a) Regular, skin-colored contours located on the right cheek. (b) Dermoscopy showing the presence of a tree-like vessel on a yellowish background. |
Dermoscopy showed the presence of a tree-like vessel on a yellowish background (Fig. 1b).
A histopathological examination revealed a cystic formation bordered by a regular, squamous epithelium, without a granular layer, resting on a thin, fibrous wall.
The lumen contains an amorphous, eosinophilic substance corresponding to abrupt keratinization of the trichilemmal type.
Our case showed a similar dermoscopic aspect to sebaceous hyperplasia. It is likely that the yellowish background corresponds to keratinous materials.
This is the first case in the literature describing the dermoscopic aspect of a trichilemmal cyst on the cheek mimicking sebaceous hyperplasia.
Consent
The examination of the patient was conducted according to the principles of the Declaration of Helsinki.
The authors certify that they have obtained all appropriate patient consent forms, in which the patients gave their consent for images and other clinical information to be included in the journal. The patients understand that their names and initials will not be published and due effort will be made to conceal their identity, but that anonymity cannot be guaranteed.
REFERENCES
1. Melikoglu C, Eren F, Keklik B, Aslan C, Sutcu M, Zeynep Tarini E. Trichilemmal cyst of the third fingertip:A case report. Hand Surg. 2014;19:131-3.
2. Ehara Y, Yoshida Y, Yanagihara S, Shiomi T, Yamamoto O. Trichilemmal cyst with dermatofibroma-like features on the leg. J Dermatol. 2017;44:71-2.
3. Clarke LE, Frauenhoffer E, Fox E, Neves R, Bruggeman RD, Helm KF. CD10-positive myofibrosarcomas:A pitfall in the differential diagnosis of atypical fibroxanthoma. J Cutan Pathol. 2010;7:737-43.
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