What are the other Names for this Condition? (Also known as/Synonyms)

• Invasive Hair Matrix Tumour of the Scalp
• Proliferating Epidermoid Cyst
• Proliferating Isthmic Cystic Carcinoma

What is Proliferating Tricholemmal Tumor? (Definition/Background Information)

• Proliferating Tricholemmal Tumor is a solitary tumor that is usually present on the scalp of elderly adults. It can present both benign and malignant behavior
• The cause of Proliferating Tricholemmal Tumor is unknown, but it could be influenced by human papilloma virus (HPV) infections. Currently, no risk factors have been clearly established
• Some lesions grow to large sizes and can result in bleeding and ulceration. Significant hair loss may also be noted with tumors on the scalp. Tumors with atypical features may behave aggressively and invade into local tissues
• The treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider
• The prognosis of benign Proliferating Tricholemmal Tumor is good with appropriate early treatment. However, the prognosis of malignant tumors may depend upon several other factors

Who gets Proliferating Tricholemmal Tumor? (Age and Sex Distribution)

• Proliferating Tricholemmal Tumor is more common in elderly adults
• Both males and females may be affected, but a strong female predominance is noticed
• There is no predilection and all races and ethnic groups may be affected

What are the Risk Factors for Proliferating Tricholemmal Tumor? (Predisposing Factors)

The risk factors for Proliferating Tricholemmal Tumor may include:

• Older adults (advancing age) have a higher risk
• Female gender

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Proliferating Tricholemmal Tumor? (Etiology)

The cause of development of Proliferating Tricholemmal Tumor is presently unknown.

• Infection due to human papilloma virus (HPV) has been described by some researchers as a probable cause
• Current studies do not definitely indicate whether the tumor originates from an existing pilar or tricholemmal cyst, or is a spontaneous ‘new’ growth
• If the tumor forms from an existing pilar cyst, then it may be triggered by irritation or an injury to the cyst

What are the Signs and Symptoms of Proliferating Tricholemmal Tumor?

The signs and symptoms of Proliferating Tricholemmal Tumor may include:

• The presence of a usually large and solitary lesion on the scalp
• The size of the lesion may vary from 2 cm to 10 cm; rarely, lesions over 25 cm in size have been reported
• The scalp is the frequent site of presentation, in 9 out of 10 cases. This is followed by the face (including the forehead), chest, abdomen, and back region
• The tumor is usually round to oval in shape and projects out from the surface of the skin
• Inflamed reddish or pinkish skin with hair loss may be noted
• Ulceration of the tumor mass can be seen

How is Proliferating Tricholemmal Tumor Diagnosed?

A diagnosis of Proliferating Tricholemmal Tumor may involve the following:

• A thorough medical history and physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis is normally undertaken to rule out the following tumors:

• Proliferating epidermoid cyst
• Proliferating infundibular cyst
• Tricholemmal carcinoma
• Tricholemmal cyst

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Proliferating Tricholemmal Tumor?

Proliferating Tricholemmal Tumor is an uncommon tumor with a borderline behavior. In some cases, it may behave in a non-cancerous manner, while tumors with atypical features can behave malignantly.

• Scratching or itching of the moles may lead to bleeding and ulceration. This can cause secondary bacterial or fungal infections to develop
• Some individuals may have concerns regarding their cosmetic appearance
• Malignant tumors can metastasize to local and regional sites if left untreated. They can also be locally invasive and destroy the surrounding tissue structures

How is Proliferating Tricholemmal Tumor Treated?

The treatment of Proliferating Tricholemmal Tumor may involve the following:

• In most cases, a wide surgical excision and removal of the entire tumor is the preferred treatment option. If a malignant transformation is noted, then this may be followed by radiation therapy and/or chemotherapy
• If the tumor has metastasized (in rare cases), then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
• Follow-up care with regular screening and check-ups are important and encouraged

How can Proliferating Tricholemmal Tumor be Prevented?

• Currently, there are no available measures to prevent the formation of a Proliferating Tricholemmal Tumor
• Regular medical screening at periodic intervals with blood tests, scans, and physical examinations are mandatory due to its metastasizing potential and possibility of recurrence. Often several years of active vigilance may be necessary

What is the Prognosis of Proliferating Tricholemmal Tumor? (Outcomes/Resolutions)

The prognosis of benign Proliferating Tricholemmal Tumor is excellent with appropriate early treatment.

• In case of a malignant Proliferating Tricholemmal Tumor, then the prognosis may depend upon various factors including the stage of the tumor, the size of the tumor, and health of the patient, among other factors
• If metastasis (such as to the local lymph nodes) is observed, then the prognosis is unpredictable

Additional and Relevant Useful Information for Proliferating Tricholemmal Tumor:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse