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Introduction: Trichoepithelioma (TE) is a rare benign adnexal tumor of follicular origin, frequently misdiagnosed due to its clinical resemblance to other cutaneous lesions, including epidermoid cysts and basal cell carcinoma.
Distinguishing these lesions is critical to prevent overtreatment or mismanagement, particularly on cosmetically sensitive facial areas.
Case Illustration: We report a case of a middle-aged female presenting with a solitary, slow-growing, skin-colored nodule on the nasal bridge. The lesion was initially suspected to be an epidermoid cyst. Dermoscopic examination revealed arborizing vessels and milia-like cysts, suggestive of TE. Histopathological evaluation confirmed the diagnosis, showing basaloid cell proliferation with follicular differentiation and keratin-filled cysts, without cellular atypia. The lesion was completely excised, and no recurrence was observed during follow-up.
Discussion: Epidermoid cysts, while also benign, exhibit different histological features such as a stratified squamous epithelial lining and keratinous content. Misdiagnosis may occur due to overlapping clinical appearance. Dermoscopy provides valuable clues, but histopathology remains the definitive diagnostic modality. Surgical excision remains the standard of care for both conditions when symptomatic or for cosmetic reasons.
Conclusion: This case highlights the diagnostic challenges in differentiating trichoepithelioma from epidermoid cysts.
A multidisciplinary approach incorporating clinical examination, dermoscopy, and histopathology is essential for accurate diagnosis and appropriate management. Increased clinical awareness is crucial, especially in primary care and dermatologic settings.