Using Mohs Micrographic Surgery to Treat a Large, Pedunculated Trichoblastoma on the Upper Cutaneous Lip

Description Trichoblastomas are uncommon adnexal tumors that usually occur on the face. We report a case of a 62-year-old White man with a large, asymptomatic, slow-growing lesion that had been on his right upper cutaneous lip for 15 years. A 2 cm pink, pedunculated nodule with telangiectasia was seen on examination. A shave biopsy was consistent with trichoblastoma: a circumscribed-appearing dermal tumor of basaloid cells arranged in cords and islands within a cellular stroma, focal epidermal connection, and papillary mesenchymal bodies. The patient elected for treatment with Mohs micrographic surgery (MMS) given the length of time that the tumor had been neglected as well as its large size, location in cosmetically sensitive area, and ability to deeply invade beyond clinical margins. The tumor was cleared after 2 stages, and a rotation flap was performed. Approximately 2 months later, the patient had achieved excellent cosmesis and was satisfied with the surgical outcome. This case highlights the utility of MMS to treat large (and in our case, neglected) facial trichoblastomas. Despite being benign tumors, trichoblastomas that are large and long-standing may have improved outcomes with MMS, especially given their ability to invade deeply beyond clinical margins. As a result of MMS, patients with large facial trichoblastomas can achieve tumor clearance and the best possible cosmetic outcome.