52-Year-Old With a Lateral Nasal Growth

Differential Diagnosis

• Epidermoid cyst
• Lobular capillary hemangioma
• Nodular basal cell carcinoma
• Trichoepithelioma

Diagnosis

This patient was diagnosed with trichoepithelioma. As benign neoplasms derived from the hair follicles, trichoepitheliomas usually present as asymptomatic smooth, skin-colored papules or nodules on the central face and scalp. Most cases occur in adults over age 40. Histopathologic examination reveals reticular basaloid islands with peripheral palisading surrounded by fibroblasts and a cellular fibrotic stroma.  Various genetic syndromes can be associated with trichoepitheliomas.

What to Look For

• Smooth, skin-colored papules most commonly on the cheeks, eyelids, and nose
• Papules are not painful or itchy and usually do not bleed

Pearls for Urgent Care Management

• Trichoepitheliomas are benign lesions
• Distinguishing these from malignant lesions requires a biopsy
• Treatment is surgical removal