Dermoscopic and Histopathological Features of Nonfamilial Multiple Trichoepitheliomas: A Case Report

Abstract

Multiple trichoepitheliomas are benign follicular tumours that usually develop during childhood or adolescence and progressively increase in number. We report the case of a 21-year-old man with multiple asymptomatic papules and nodules involving the face, scalp and upper trunk since the age of 13 years, with no family history of similar lesions. Dermoscopy showed prominent arborising telangiectasias, ivory-white structureless areas and milia-like cysts. Because several lesions raised concern for basal cell carcinoma (BCC), three lesions located on the face, scalp and back were biopsied. Histopathology of all three specimens showed a symmetrical, well-circumscribed dermal basaloid proliferation with keratin-filled lumina and a cellular, focally hyalinised stroma, without peripheral palisading, stromal retraction clefts or malignant proliferation. Genetic testing was unavailable, and the diagnosis of nonfamilial multiple trichoepitheliomas was based on the clinical presentation, absence of a family history and concordant histopathology. Topical rapamycin 1% provided limited cosmetic improvement after three months. Carbon dioxide laser therapy was considered, but was not financially accessible. The patient remains under regular dermatological follow-up.