Trichilemmomas are benign hair follicle neoplasms that I occasionally encounter in both my The Woodlands dermatology and Conroe dermatology clinics. Trichilemmomas appear clinically as small flesh colored papules on the face and may be mistaken for basal cell cancers. Trichilemmomas are usually solitary but when they are multiple it is worrisome for Cowden's Syndrome. Patients with Cowden Syndrome have a 40 to 50% chance of developing an internal malignancy such as breast and thyroid cancer. Skin cancers are also very prevalent in Cowden's Syndrome as the genetic defect is a mutation in the PTEN tumor suppressor gene. Treatment of Trichilemmomas are with shave excision, laser resurfacing and dermabrasion if desired.
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