International Journal of Head and Neck Surgery

Register      Login

VOLUME 5 , ISSUE 3 ( September-December, 2014 ) > List of Articles


Squamous Cell Carcinoma of the Scalp Masquerading as Trichilemmal Tumor of the Scalp

Sudhir Naik, Rajshekar Halkud, A Nanjundappa, Siddharth Biswas, M Samskruthi, Purshottam Chavan, KT Sidappa, Bindu Venugopal

Citation Information : Naik S, Halkud R, Nanjundappa A, Biswas S, Samskruthi M, Chavan P, Sidappa K, Venugopal B. Squamous Cell Carcinoma of the Scalp Masquerading as Trichilemmal Tumor of the Scalp. Int J Head Neck Surg 2014; 5 (3):144-147.

DOI: 10.5005/jp-journals-10001-1201

Published Online: 01-03-2016

Copyright Statement:  Copyright © 2014; The Author(s).



Adnexal components tumors of the skin are very rare and are seen as benign lesions of the scalp in aged women. Trichilemmal tumor is usually benign and rarely under-goes malignant transformation in a stepwise manner starting with an adenomatous stage of the trichilemmal cyst to an epitheliomatous stage of the proliferating trichilemmal tumor (PTT) evolving into the carcinomatous stage of the malignant proliferating trichilemmal tumor (MPTT).

Case report

A 53-year-old woman reported with huge swelling in the posterior region of the scalp. The swelling was mobile and soft to firm in consistency not fixed to the skull bone. The surface was smooth and getting under the swelling was not possible, needle biopsy reported as trichilemmal tumor. Contrast enhanced computed tomography (CECT) neck did not show any nodes in the neck, especially the posterior compartment. The tumor was widely excised with 1 cm margin and the periosteum was kept intact with split skin graft. An area of periosteal adher ence to the tumor seen was excised. The histopathology report on serial sectioning reported grade 1 moderately differentiated squamous cell carcinoma (SCC). Postoperative external beam radiotherapy of 66 Gy was given. The patient is being followed up and no recurrence is seen.


Malignant transformation in a proliferating trichilemmal tumor a rare entity and should be differentiated from SCC and the better prognostic trichilemmal carcinoma. A protocolbased adjuvant therapy is available for squamous cell carcinoma but not for trichilemmal carcinoma (TLC) and MPTT. A major meta-analysis may help to establish a clinical outcome-based classification and management protocol for these tumors.

How to cite this article

Nanjundappa A, Halkud R, Venugopal B, Chavan P, Sidappa KT, Biswas S, Samskruthi M, Naik SM. Squamous Cell Carcinoma of the Scalp Masquerading as Trichi-lemmal Tumor of the Scalp. Int J Head Neck Surg 2014;5(3):144-147.

PDF Share
  1. Malignant pilar tumor of the scalp: a case report and review of literature. J Cancer Res Ther Dec 2007;3(4): 240-243.
  2. Cutaneous adnexal tumors: a guide to pathologic diagnosis. Chicago, IL: ASCP Press; 1991. p. 2; 113-168.
  3. Proliferating trichilemmal tumors: a review of the literature. Dermatol Surg 2007 Sep;33(9):1102-1108.
  4. Proliferating pilar tumors: a clinicopathologic study of 76 cases with a proposal for definition of benign and malignant variants. Am J Clin Pathol 2004;122(3):566-574.
  5. Malignant proliferating trichilemmal tumour presenting early in life: an uncommon feature. J Cutan Aesthet Surg 2011;4(1):51-55.
  6. Proliferating trichilemmal cyst: a simulant of squamous cell carcinoma. Cancer 1981;48(2):1207-1214.
  7. Malignant proliferating trichilemmal tumor of the scalp: a case report. Dermatol Online J 2008;14(3):11.
  8. Malignant proliferating trichilemmal cyst: a case report with review of literature. Malays J Pathol 2009;31(2):71-76.
  9. Development of a malignant proliferating trichilemmal cysts. Dermatologica 1983;166(2):203-208.
  10. Skin adnexal neoplasms-part 1: an approach to tumours of the pilosebaceous unit. Clin Pathol 2007;60(2):129-144.
  11. Tumours of the hair follicle. In: McKee PH, Calonje E, Granter SR, editors. Pathology of the skin with clinical correlations. 3rd ed. Amsterdam: Elsevier; 2005. p. 1519-1563.
  12. Mixed tumors with follicular differentiation: complex neoplasms of the primary epithelial germ. Int J Dermatol 1995;34(5):782-785.
  13. Tumors of the epidermal appendages. Elder DE. Lever's histopathology of the skin. 9th ed. Philadelphia, PA: Lippincott Williams and Wilikins; 2005. p. 867-926.
  14. Nucleolar organizer regions (NORs) in simple and proliferating trichilemmal cysts (pilar cysts and pilar tumors). Ind J Pathol Microbiol 2004;47(1):469-473.
  15. Neoplasia. In: Kumar V, Abbas AK, Fausto N, Aster J, editors. Robbins and Cotran Pathologic Basis of Disease. 8th ed. New Delhi: Elsevier; 2010. p. 173-223.
  16. A malignant proliferating trichilemmal tumor simulating a squamous cell carcinoma. Eur J Plast Surg 1997;20(3):320-322.
  17. Trichilemmal carcinoma: clinicopathologic study of 10 cases. J Cutan Pathol 1992;19(1):100-109.
  18. Proliferating trichilemmal tumors: CT and MR imaging findings in two cases, one with malignant transformation. AJNR 2001;22(2): 180-183.
  19. Proliferating trichilemmal tumors: clinicopathologic evaluation is a guide to biologic behavior. J Cutan Pathol 2003;30(2): 492-498.
  20. Metastatic adenocarcinoma. Am J Dermatopathol 2004;26(4):447-451.
  21. Malignant proliferating trichilemmal tumors: an histopathologic and immunohistochemical study of three cases with DNA ploidy and morphometric evaluation. Histopathology 1998;33(3):542-546.
  22. Proliferating trichilemmal cyst. J Cutan Pathol 1983;10(2):178-187.
  23. Trichilemmal carcinoma: review of 8 cases. J Cutan Pathol 1993;20(2):44-49.
  24. Lymphoepithelioma-like carcinoma of the skin. J Dermatol 1996;23(7): 472-475.
  25. Radiotherapy for epithelial skin cancer. Int J Radiat Oncol Biol Phys 2001;51(3):748-755.
  26. Electron beam therapy is not inferior to superficial x-ray therapy in skin carcinoma. Int J Radiat Oncol Biol Phys 1995;32(5): 1347-1350.
  27. Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin. Int J Radiat Oncol Biol Phys 2004;60(2):406-411.
  28. Pilar tumor. A distinctive type of trichilemmoma. Diagn Histopathol 1982;5:157-167.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.