10.5826/dpc.1401a9
text/xml
2160-9381
3294
en
Giuseppe Argenziano
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
basal cell carcinoma
Pigmented Trichoepitheliomas, Not an Uncommon Variant: A Dermoscopical Insight
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-02-28
2024-01-31
2024-02-21
e2024009
Dermatol Pract Concept
Giuseppe Argenziano
2024/01/31
10.5826/dpc.1401a9
e2024009
Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
2160-9381
basal cell carcinoma
en
e2024009
Sławińska M, Płaszczyńska A, Lakomy J, et al. Significance of Dermoscopy in Association with Clinical Features in Differentiation of Basal Cell Carcinoma and Benign Trichoblastic Tumours. Cancers (Basel). 2022;14(16):3964. DOI: 10.3390/cancers14163964. PMID: 36010957. PMCID: PMC9406107
Pigmented Trichoepitheliomas, Not an Uncommon Variant: A Dermoscopical Insight
https://dpcj.org/index.php/dpc/article/download/3294/2541
  Pigmented Trichoepitheliomas, Not an Uncommon
         Variant: A Dermoscopical Insight
    Stefano Caccavale1, Maria Pia Boccellino1, Carmine Fiorentino1, Giuseppe Argenziano1


1 Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples,
  Italy



Key words: dermoscopy, pigmented trichoepithelioma, trichoepithelioma, basal cell carcinoma
Citation: Caccavale S, Boccellino MP, Fiorentino C, Argenziano G. Pigmented Trichoepitheliomas, Not an Uncommon Variant:
A Dermoscopical Insight. Dermatol Pract Concept. 2024;14(1):e2024009. DOI: https://doi.org/10.5826/dpc.1401a9
Accepted: July 30, 2023; Published: January 2024
Copyright: ©2024 Caccavale et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Stefano Caccavale, MD, Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine,
University of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy; phone: +39 3336365526; fax: +39 0815468759;
E-mail: stefano85med@libero.it




Introduction                                                             our Dermatology Unit. Our database included 86 TEs in
                                                                         80 ­
                                                                            patients in the considered period. Among these ones,
Trichoepitheliomas (TEs) are uncommon benign tumors                      77 ­lesions could be clinically and dermoscopically evaluated.
derived from the hair follicles. They most often occur in                     The average age of our patients at diagnosis was 59 years
women, and present as asymptomatic translucent, round                    (range, 26–84 years). A large predominance for female gen-
papules or nodules mainly localized on the face or scalp [1].            der was found (63.7%). TEs were found in the following
They may appear as solitary or multiple lesions, presenting              areas: head (82.6% of the lesions), trunk (12.8%), neck
as familial or non-familial forms, sometimes associated with             (3.5%), upper limbs (1.1%).
genetic syndromes [2].                                                        The dermoscopic features of all histologically confirmed
    So far, in literature TEs have been widely described as              TEs were evaluated by 3 dermatologists independently
translucent non-pigmented papules with mostly milia-like                 and the final results were taken from the mean of their
cysts, shiny-white background, short and thin telangiectasias            observations.
on dermoscopy [3].                                                            The major part [47/77 (61.0%)] of these TEs showed to
                                                                         be (more or less) pigmented. We sub-classified pigmented

Case Presentation                                                        TEs based on the percentage of their pigmentation, expressed
                                                                         as higher than 50% of the lesion area, between 50% and
We analyzed all histologically confirmed TEs arising over                10% and less than 10%. Pigmentation percentage >50%
a 17-year period (January 2005- December 2021). Clin-                    was found in 42.6% (20) of TEs. Pigmentation percentage
ical and dermoscopic images of histologically-confirmed                  among 50 and 10% was found in 12 cases, and <10% in
TEs were retrospectively collected from the database of                  15 cases.




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024009                                                                            1
          Figure 1. Three examples of trichoepitheliomas classified based on the percentage of pigmentation. (A,B) Clinical
          picture and dermoscopy of < 10% pigmented trichoepithelioma of the right cheek; (C,D) trichoepithelioma of the
          left supralabial region showing 10%-50% pigmentation expressed mostly as brown globules; (E,F) trichoepitheli-
          oma of the left nasolabial fold expressing >50% pigmentation as brown globules and blue/black blotches.




    The patterns of pigmentation were mainly character-             percentage of pigmentation (> 50%) in the majority of
ized by brown globules, observed in 64% of pigmented                cases. Milia-like cysts and whitish background, which are
TEs (30/47), brown-blue nests in 34% (16/47), black-blue            described in literature as the main dermoscopic features,
blotches in 17% (8/47), and leaf-like areas in 8.5% (4/47).         were found, instead, to be much less prevalent among pig-
    Arborizing vessels (76.6%) were overall the most com-           mented TEs.
mon dermoscopic features (seen in 66% of pigmented
and in 90% of non-pigmented TEs), followed by shiny
                                                                    Conclusions
white lines (32% among pigmented TEs and 40% among
non-pigmented TEs). Milia-like cysts were found in 43.3%            Differential diagnosis with basal cell carcinoma (BCC) with-
of non-pigmented TEs, while only 17% of pigmented TEs               out histological confirmation remains difficult. However,
showed this feature. A whitish background was found in              pigmented papules, especially localized on the face, that
50% of non-pigmented TEs.                                           show dermoscopic features like brown globules, brown-blue
    Literature data regarding TEs describe them as mainly           nests, and arborizing vessels should let the dermatologists
non-pigmented papule, but as we experienced in our pa-              think, especially in young women, to pigmented trichoepi-
tients, most of TEs were instead pigmented, with a high             theliomas and not only to BCCs.



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Research Letter | Dermatol Pract Concept. 2024;14(1):e2024009                                                                       3
