Trichoblastoma mimicking basal cell carcinoma and the approach to its management: Case report

Trichoblastoma is a benign and rare cutaneous lesion with striking resemblance to basal cell carcinoma. However, the course of the illness varies significantly from basal cell carcinoma. It usually takes a less malicious route and causes minimal harm to the patient,unlike basal cell carcinoma where it can be aggressive and requires additional radiotherapy. Therefore, being able to differentiate them from one another is crucial to properly set a management plan.

A 44-year-old Saudi male, diagnosed with basal cell carcinoma of the scalp in Dammam Medical Centre (DMC) and was referred to our hospital for re-excision of positive margins. Slide review of the histopathology samples in our hospital showed features consistent with trichoblastoma. This was further confirmed by a dermahistopathologist.

This rare benign tumour has posed multiple challenges in the clinical setting as not enough studies were conducted in order to dictate a proper management course. However, current management approach to the majority of skin lesions rely on the histopathological subtype and surgical excision. Many benign and malignant dermatological entities may mimic basal cell carcinoma, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. It is important to request the proper investigations to ease the process of diagnosis and more importantly, the process of differentiation.

Differentiating the two tumours from one another allows for the initiation of proper treatment early resulting in an improved prognosis for both lesions. The gold standard investigation to diagnose and differentiate between them is a surgical biopsy. Trichoblastoma typically has a favourable prognosis with a low incidence of recurrence or progression.