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Cutaneous Adnexal Neoplasms pp 567–589Cite as

Inverted Follicular Keratosis and Tricholemmoma

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Abstract

Inverted follicular keratosis clinically presents as a papular lesion on the head and neck, and it is often mistaken for verruca vulgaris, seborrheic keratosis, or basal cell carcinoma.

Histopathologically, inverted follicular keratosis shares features with viral warts, including hyperkeratosis, orthokeratosis, thickening of the stratum granulosum, and dilated capillaries in the papillary dermis. Differentiating features include squamous eddies and lack of koilocytes.

Tricholemmomas present as small popular or polypoid lesions that arise most commonly on the face and clinically are confused with basal cell carcinoma, verruca vulgaris, or melanocytic nevus.

Histopathologically, tricholemmomas share also many features with warts, including verrucous or papillomatous surface, hyperkeratosis, focal parakeratosis, and hypergranulosis. Unique features to this entity include clear, pale, or eosinophilic lobules of cells extending from the epidermis, with peripheral palisading and a thick basement membrane, similar to the vitreous lamina of the normal hair follicle.

Desmoplastic tricholemmoma is characterized by a desmoplastic stroma and sclerotic collagen bundles around cords and small aggregates of pale epithelial cells.

The presence of multiple tricholemmomas should prompt consideration to the diagnosis of Cowden syndrome, which also increases the risk for multiple internal carcinomas.

While the histogenesis of both inverted follicular keratosis and tricholemmoma has historically been controversial, both entities represent viral warts with tricholemmal differentiation.

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Authors and Affiliations

  1. Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain

    Luis Requena

  2. Department of Pathology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA

    Omar Sangüeza

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  1. Luis Requena
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Requena, L., Sangüeza, O. (2017). Inverted Follicular Keratosis and Tricholemmoma. In: Cutaneous Adnexal Neoplasms. Springer, Cham. https://doi.org/10.1007/978-3-319-45704-8_49

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  • DOI: https://doi.org/10.1007/978-3-319-45704-8_49

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