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Abstract

Cutaneous lesions on the face and scalp have the potential for clinical and histopathological misdiagnosis due to their broad differential diagnosis and overlapping features. A 43 year old Caucasian female presented to clinic for an enlarging lesion but asymptomatic lesion on the right upper eyelid present for the last 10 years. Examination revealed a 1.5cm slightly erythematous nodule on the right supraorbital region without central punctum or active drainage. The clinical impression favored an inflamed epidermal inclusion cyst. On excision a 1.1cm x 1.1cm cystic nodule was removed from the right supraorbital region and sent to histopathologic evaluation. Histopathology revealed a cystic follicular dilatation with keratinaceous debris and free hair shafts with surrounding sebaceous hyperplasia and abundant fibrous stroma. Initial review sparked debate regarding the spectrum of lesions that fall between that of a follicular sebaceous cystic hamartoma and the similar appearing counterparts of trichofolliculomas and sebaceous trichofolliculomas. Given the findings of isolated secondary hair structures, including sections with a hair shaft and hair bulb, consensus favored a sebaceous trichofolliculoma over that of the less often seen follicular sebaceous cystic hamartoma. The lack of prominent secondary hair structures and significant sebaceous glands in the setting of lesion present reportedly for a decade lends support to the argument that follicular sebaceous cystic hamartoma likely exist on spectrum with trichofolliculoma and may even represent an end stage differentiation in some lesions. This interesting case lends itself to highlighting the finer differences in the spectrum of these lesions discussed above.