Appl Immunohistochem Mol Morphol 2018 Apr 7. Epub 2018 Apr 7.

Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.

Ber-EP4 has been the traditional immunostain used for the detection of basaloid skin tumors. Recently, MOC-31 has shown be superior to Ber-EP4 in the detection of basosquamous basal cell carcinoma (BCC) and many centers are now using both Ber-EP4 and MOC-31 antibodies together to detect these lesions. The objective of this study was to compare the utility of using both Ber-EP4 and MOC-31 immunostains in the detection of basaloid skin tumors and to better characterize the previously unknown staining properties of MOC-31 in cutaneous lesions. Read More

Ann Pathol 2018 Apr 2. Epub 2018 Apr 2.

Service de dermatologie, CHU de Caen, avenue côte-de-nacre, 14033 Caen, France.

We report a case of microcystic adnexal carcinoma in a 80-year-old woman. This is a rare malignant adnexal cutaneous tumor with glandular and follicular differentiation, rare, often asymptomatic, with late diagnosis and slow growth, locally aggressive and rarely metastatic. The distinction with other benign and malignant skin tumors is difficult. Read More

Int J Trichology 2017 Oct-Dec;9(4):181-183

Department of Pathology, Clínica Las Condes, Santiago, Chile.

Trichofolliculoma (TF) is a hamartomatous hair follicle-related tumor, clinically described as a dome-shaped papule with a central pore crossed by one or more silky white hairs. Histologically, it described as a cystic cavity containing keratinous debris, hair shaft fragments, and numerous hair follicles arising from its linings. Collision or compound tumors are a coexistence of two or more identifiable tumors in the same lesion. Read More

Arch Pathol Lab Med 2017 Nov;141(11):1490-1502

From the Departments of Pathology (Drs Stanoszek, Wang, and Harms) and Dermatology (Dr Harms), University of Michigan Medical School, Ann Arbor. Drs Stanoszek and Wang contributed equally.

Context: - Basal cell carcinoma (BCC) is the most common human malignant neoplasm and is a frequently encountered diagnosis in dermatopathology. Although BCC may be locally destructive, it rarely metastasizes. Many diagnostic entities display morphologic and immunophenotypic overlap with BCC, including nonneoplastic processes, such as follicular induction over dermatofibroma; benign follicular tumors, such as trichoblastoma, trichoepithelioma, or basaloid follicular hamartoma; and malignant tumors, such as sebaceous carcinoma or Merkel cell carcinoma. Read More

Am J Dermatopathol 2017 Oct 2. Epub 2017 Oct 2.

*Dermatology Department, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania; and †Dermatopathology Laboratory, Dermatologikum, Hamburg, Germany.

Induction of follicular germinative structures above a dermatofibroma (DF) is a common finding. Rarely, induction of a trichoblastoma in a DF has been observed. Here, we report the case of a desmoplastic trichoepithelioma induced by a DF. Read More

Indian Dermatol Online J 2017 Sep-Oct;8(5):358-360

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

Trichoepithelioma is a benign tumor of follicular unit. It has been rarely described as the cause of leonine facies. We are presenting a classical case of multiple familial trichoepitheliomas (MFTs) with characteristic histopathological features leading to leonine facies. Read More

Clin Exp Dermatol 2017 Dec 4;42(8):906-909. Epub 2017 Oct 4.

Department of Dermatology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey.

Brooke-Spiegler syndrome (BSS) is a rare, autosomal dominant disorder characterized by multiple adnexal tumours, especially trichoepitheliomas, cylindromas and occasionally spiradenomas. These lesions usually begin to appear in the second or third decade of life. Malignant transformation of pre-existing tumours may occur. Read More

Clin Exp Dermatol 2018 Jan 20;43(1):108-109. Epub 2017 Sep 20.

Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea.

J Clin Diagn Res 2017 Jul 1;11(7):MD09-MD10. Epub 2017 Jul 1.

Junior Resident, Department of Ear, Nose and Throat, Sri Siddhartha Medical College, Agalakote, Karnataka, India.

Nevus sebaceus of Jadassohn is a congenital tumour affecting the scalp and face. It is usually presented as a pigmented patch or plaque. It is a complex cutaneous hamartoma which involves pilosebaceous follicle, epidermis and adnexal structures. Read More

Saudi J Ophthalmol 2017 Jul-Sep;31(3):183-185. Epub 2017 May 17.

New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, United States.

Trichilemmal carcinomas are rare malignant adnexal tumors which can involve the head and, rarely, the eyelid. Accurate diagnosis and differentiation from basal cell carcinoma or trichoepithelioma are dependent on histopathological and immunohistochemical analysis. We report a case of an eyelid mass, initially diagnosed by incisional biopsy as a trichoepithelioma, later found on excisional biopsy to be a trichilemmal carcinoma and present a review of the literature of the histopathology, differential diagnosis and management. Read More

Open Access Maced J Med Sci 2017 Jul 19;5(4):439-444. Epub 2017 Jul 19.

Medical Institute of Ministry of Interior (MVR), Department of Dermatology and Dermatologic Surgery, General Skobelev 79, 1606 Sofia, Bulgaria; Onkoderma - Policlinic for Dermatology, Venereology and Dermatologic Surgery, 26 General Skobelev blvd., Sofia, Bulgaria.

Background: Fibroepithelioma of Pinkus (FeP) is an uncommon and controversial skin lesion, sharing features of both basal cell carcinoma (BCC) and trichoepithelioma. In this article, we present a case of FeP and synthesise current concepts on the etiopathogenesis, diagnosis and treatment of this uncommon tumour.

Case Report: We report the case of an 88-year-old male patient presenting to the dermatology clinic for a sharply demarcated, pink, exophytic cutaneous tumour situated in the left inguinal region. Read More

Curr Treat Options Oncol 2017 Aug;18(8):49

St Helens and Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Road, St Helens, WA9 3DA, UK.

Opinion Statement: Microcystic adnexal carcinoma (MAC) is a rare, slow-growing, infiltrative malignant tumour most commonly found on the head and neck. It often presents as a solitary skin-coloured or yellow papule, plaque or nodule. Ultraviolet radiation, immunosuppression and ionising radiation are possible risk factors. Read More

Dermatol Surg 2017 Aug;43(8):1012-1016

*Division of Dermatology, Department of Internal Medicine, Washington University, St. Louis, Missouri; †Department of Pathology and Immunology, Washington University, St. Louis, Missouri.

Background: Microcystic adnexal carcinoma (MAC) is a rare, locally aggressive cutaneous neoplasm that commonly occurs on the face.

Objective: The purpose of this article is to comprehensively review the current literature on MAC pertaining to epidemiology, pathogenesis, clinical presentation, histology, immunohistochemistry, prognosis, follow-up, and treatment.

Materials And Methods: An extensive literature review was conducted using OVID MEDLINE and PubMed to identify articles relating to MAC. Read More

Dermatol Online J 2017 Jun 15;23(6). Epub 2017 Jun 15.

Department of Dermatology, Hospital de Santarém EPE, Santarém, Portugal.

A healthy 31-year-old woman presented with a 20-year history of asymptomatic skin-colored papules and nodules on the central area of the face. Her maternal grandmother, aunts, mother, and sister also had similar lesions. Clinical, histopathological, and genetic features allowed the diagnosis of multiple familial trichoepithelioma. Read More

Dermatol Online J 2017 May 15;23(5). Epub 2017 May 15.

Division of Dermatology, Department of Medicine, National University Hospital, Singapore. ellie_

Basaloid follicular hamartoma (BFH) is a rare benign adnexal tumor with variable clinical presentation. We report a case of a 64-year-old man, who presented with an incidental finding of a 3mm hyperpigmented macule on his cheek. Dermoscopy revealed a structureless blue lesion. Read More

J Cutan Pathol 2017 May 16. Epub 2017 May 16.

Division of Dermatopathology, University of Virginia Medical Center, Charlottesville, Virginia.

J Dermatol 2017 Sep 10;44(9):e228-e229. Epub 2017 May 10.

Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.

Int J Trichology 2016 Oct-Dec;8(4):165-167

Department of Pediatrics, Medical College, Calicut, Kerala, India.

Epithelioma adenoides cysticum or multiple trichoepitheliomas are rare benign hamartomas arising from the hair germ. A 35-year-old female presented with multiple skin-colored firm papules and nodules mainly affecting the central face, scalp, and external ear canal since the age of 9 years. The lesions gradually increased with age. Read More

Am J Dermatopathol 2017 Apr;39(4):279-286

*Departments of Pathology, Porto Medical School and Sao Joao Hospital, Porto, Portugal; †Departments of Pathology, William Beaumont School of Medicine, Royal Oak, MI; ‡Departments of Pathology, Duke University Medical Center, Durham, NC; and §Departments of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA.

Knowledge of staining pattern of certain immunostains might be useful in the classification of cutaneous adnexal tumors that can have clinical importance. We studied GATA3 and MYB expression in archival materials of 220 adnexal tumors comprised of sebaceous carcinomas, follicular tumors, apocrine carcinoma, predominantly apocrine tumors, predominantly eccrine tumors, and others including adenoid cystic carcinomas. Nuclear GATA3 expression was seen in 70% (153/220) of cases, including sebaceous carcinoma (93%), apocrine carcinoma (93%), follicular neoplasms (100%), and predominantly apocrine neoplasms (69%), yet only 38% of predominantly eccrine neoplasms. Read More

J Clin Diagn Res 2017 Jan 1;11(1):ED05-ED06. Epub 2017 Jan 1.

Associate Professor, Department of Pathology, Shaheed Hasan Khan Mewati, Government Medical College , Nalhar, Nuh, Haryana, India .

Trichoadenoma is a rare benign, slowly growing, cutaneous tumour of the hair follicle first described by Nikolowski in 1958. It presents as a non-specific nodule over the face or buttocks. However, unusual sites such as the neck, upper arm, thigh, shoulder, and shaft of the penis may also be affected. Read More

Vet Clin Pathol 2017 Mar 1;46(1):143-150. Epub 2017 Mar 1.

Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California-Davis, California, USA.

Background: Follicular tumors and cysts are common skin lesions in dogs. Both are distinguished based on their cellular origin (matrical, isthmus, or infundibular cells) and the type of keratin they produce. Typically, differentiation requires histopathology, as all these lesions often have similar cytologic features. Read More

Dermatol Ther 2017 Mar 30;30(2). Epub 2017 Jan 30.

Department of Dermatology, Stanford University, Palo Alto, California.

The management of trichoepitheliomas is challenging, especially in children. This challenge is exemplified in patients with multiple trichoepitheliomas who present with progression of lesion count and size despite treatment with current strategies, including CO laser and surgery. We present the novel use of topical 1% sirolimus cream in two siblings with multiple facial trichoepitheliomas; one was treated with a combination of CO laser ablation and topical sirolimus, and the other was treated with topical sirolimus alone. Read More

Case Rep Obstet Gynecol 2016 29;2016:6829194. Epub 2016 Dec 29.

Department of Obstetrics and Gynecology, Seirei Hamamatsu General Hospital, Shizuoka, Japan.

Here, we report an extremely rare case of trichoepithelioma (TE)-a benign epithelial tumor originating from the outer root sheath of a hair follicle-arising in an ovarian mature cystic teratoma (MCT) with fluorodeoxyglucose-positron emission tomography (FDG-PET) findings. A 48-year-old Japanese woman presented to our hospital for her annual follow-up of adenomyosis. Ultrasonography and magnetic resonance imaging revealed a left ovarian tumor with irregular-shaped septum, which was suspicious of malignancy. Read More

Am J Dermatopathol 2017 Oct;39(10):793-794

Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic.

Skinmed 2016 1;14(6):467-468. Epub 2016 Dec 1.

Department of Dermatology, Robert Wood Johnson University Hospital, New Brunswick, NJ.

A 33-year-old woman presented with more than 100 flesh-colored papules and nodules centrally located on the face (Figure 1). Since their first appearance at the age of 7, the lesions had increased in number and spread laterally from the nasolabial folds. She underwent surgical removal at age 10 with recurrence afterward. Read More

Indian J Dermatol 2016 Sep-Oct;61(5):580

Department of Dermatology, University Hospital Puerta del Mar, Andalusian Health Service, Cádiz, Spain.

Brooke-Spiegler Syndrome (BSS) is a rare genodermatosis characterized by the progressive formation of adnexal skin tumors in the scalp and face, mainly trichoepitheliomas, cylindromas, and spiradenomas. It has also been associated with salivary glands neoplasms. It is due to mutations in the tumor suppressor gene cylindromatosis (CYLD gene) localized on chromosome 16q12-q13. Read More

Dermatol Pract Concept 2016 Jul 31;6(3):51-4. Epub 2016 Jul 31.

Department of Dermatology, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile.

Trichoepitheliomas are uncommon benign adnexal neoplasms that originate from the hair follicles. Multiple familial trichoepithelioma constitute an autosomal dominant disease characterized by the appearance of multiple flesh-colored, symmetrical papules, tumors and/or nodules in the central face and occasionally on the scalp. Although clinical diagnosis is usually straightforward in light of the family history and naked-eye examination, dermoscopy may aid in its confirmation. Read More

Fukuoka Igaku Zasshi 2016 08;107(8):155-60

We here describe a case of solitary basaloid follicular hamartoma (BFH) : the case developing in company with senile lentigo on the nose. BFH is a relatively rare benign follicular neoplasm of undetermined etiology. Histologically, the specimen consisted of small-sized squamoid or basaloid cells and follicular germ-like cells in the periphery of the tumor nests. Read More

Clin Exp Dermatol 2016 Aug 24;41(6):682-4. Epub 2016 Jun 24.

Institute of Medical Biology, Immunos, Singapore.

Dermatol Ther (Heidelb) 2016 Sep 21;6(3):347-62. Epub 2016 Jun 21.

Department of Dermatology, University of California San Diego, San Diego, CA, USA.

Background: Fibroepithelioma of Pinkus (FeP) is considered a variant of basal cell carcinoma (BCC); however, in the past 20 years, some researchers have argued for its classification as a trichoblastoma. Recently, use of a new immunostaining marker and further dermoscopic characterization of FeP have advanced the debate about its proper classification.

Purpose: A review of the evidence for and against classification of FeP as BCC or trichoblastoma is presented. Read More

Indian J Dermatol 2016 May-Jun;61(3):348

Department of Neurosurgery, Affiliated Hospital of Jining Medical College, Jining, Shandong, PR China.

Long-standing trichoepithelioma lesion on scalp with 12 years follow-up. The patient was observed for 12 years, and the carcinoma recurred 3 times during 8 years after surgical excision and radiation therapy. Malignant transformation may occur in multiple familial trichoepitheliomas; Moderate radiation therapy should be given for malignant transformation patients with lower radiation dose and shorter time. Read More

Ann Dermatol 2016 Jun 25;28(3):411-3. Epub 2016 May 25.

Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea.

J Cutan Pathol 2016 Aug 10;43(8):649-56. Epub 2016 Jun 10.

Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Sebaceous carcinoma is a rare but serious malignancy that may be difficult to diagnose when poorly differentiated. Other epithelial tumors with clear cell change may mimic sebaceous carcinoma. Few useful or specific immunohistochemical markers for sebaceous differentiation are available. Read More

J Clin Diagn Res 2016 Mar 1;10(3):PD17-9. Epub 2016 Mar 1.

Professor and HOD, Department of Pathology, ASRAMS , Eluru, Andhra Pradesh, India .

Trichoepitheliomas (TE) are benign tumours but occasionally can undergo transformation to malignant neoplasms more commonly as Basal Cell Carcinoma (BCC). The correct diagnosis between these tumours is very important because basal cell carcinoma is locally aggressive neoplasm and requires total surgical excision with wide healthy margins while trichoepithelioma needs simple excision. We describe three patients who developed basal cell carcinoma with facial trichoepitheliomas. Read More

Eur J Plast Surg 2016;39:143-146. Epub 2015 Jun 17.

Department of Plastic and Reconstructive Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka India.

A young male patient presented with multiple swellings on his chest and the nape of his neck. Physical examination revealed multiple small papulonodular swellings measuring 0.5 × 0. Read More

Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2016 Apr;33(2):168

Department of Dermatology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China.

Head Neck Pathol 2016 Jun 14;10(2):125-30. Epub 2016 Mar 14.

Department of Pathology, Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic.

Brooke-Spiegler syndrome (BSS) is an inherited autosomal dominant disease characterized by the development of multiple adnexal cutaneous neoplasms most commonly spiradenoma, cylindroma, spiradenocylindroma, and trichoepithelioma. Multiple familial trichoepithelioma (MFT) is a phenotypic variant of the disease characterized by the development of numerous trichoepitheliomas (cribriform trichoblastoma) only. Malignant tumors arise in association with preexisting benign cutaneous neoplasms in about 5-10% of the patients . Read More

Indian J Dermatol 2016 Jan-Feb;61(1):78-80

Department of Dermatology, Venereology, Leprosy, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.

Trichoepithelioma is a rare benign adnexal tumor which may be of solitary nonfamilial type or multiple familial trichoepitheliomas. Here, we describe a rare presentation of nonfamilial case of trichoepithelioma in a 50-year-old female with multiple skin colored facial papules and nodules over the face, upper back, and extremities. Read More

BMC Genet 2016 Feb 9;17:36. Epub 2016 Feb 9.

MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary.

Background: Multiple familial trichoepithelioma type 1 (MFT1; MIM 601606), a rare monogenic skin disease with autosomal dominant inheritance, is characterized by the development of multiple skin-colored papules on the central area of the face, frequently occurring in the nasolabial area. The disease is associated with various mutations in the cylindromatosis (CYLD; MIM 605018) gene that are also responsible for familial cylindromatosis (FC) and Brooke-Spiegler syndrome (BSS).

Methods: Recently we have identified a Spanish MFT1 pedigree with two affected family members (father and daughter). Read More

Oncol Lett 2015 Dec 13;10(6):3466-3470. Epub 2015 Oct 13.

Department of Pathology, Kafkas University, Kars 36100, Turkey.

Differential diagnosis of trichoepithelioma (TE) and basal cell carcinoma (BCC) on the basis of clinical symptoms and laboratory investigations may be difficult in certain patients. The aim of the present study was to compare cluster of differentiation 10 (CD10) and androgen receptor (AR) expression patterns in BCC and TE, to investigate the predictive power of these proteins as markers of the two conditions. A total of 39 cases of BCC and 15 cases of TE were retrieved from the pathology department archives. Read More

Dermatol Online J 2016 Nov 15;22(11). Epub 2016 Nov 15.

Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.

Trichoepitheliomas are trichogenic tumors that can have various clinical morphologies. These tumors are benign and differentiate toward the outer root sheath of the hair follicle. Solitary trichoepitheliomas arise sporadically, in contrast to multiple trichoepitheliomas, which are usually inherited as an autosomal dominant trait or as part of various genetic syndromes. Read More

Oncol Lett 2015 Oct 21;10(4):2468-2476. Epub 2015 Jul 21.

Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.

Desmoplastic trichoepithelioma (DTE) is a rare benign adnexal tumor with the characteristic features of asymptomatic, solitary, annular, indurated and centrally depressed papules or plaques, most commonly occurring in younger individuals on the face. Microscopically and clinically, DTE may be difficult to distinguish from other cutaneous adnexal neoplasms, particularly syringoma, cutaneous metastatic breast cancer, morpheaform basal cell carcinoma and microcystic adnexal carcinoma. The present study reports three cases of DTE. Read More

Am J Dermatopathol 2015 Dec;37(12):885-91

Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

Initial investigations reported GATA3 to be a sensitive and relatively specific marker for mammary and urothelial carcinomas. Recently, GATA3 expression has been described in several other epithelial tumors. However, there has been only limited investigation of GATA3 expression in cutaneous epithelial tumors. Read More

Histol Histopathol 2016 Apr 17;31(4):453-9. Epub 2015 Nov 17.

Laboratory of Veterinary Pathology, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan.

CD146, a cell adhesion molecule, is overexpressed in a variety of carcinomas, including melanoma, prostate cancer, epithelial ovarian cancer, and breast cancer. The level of expression is directly correlated with tumour progression and metastatic potential. The most commonly affected organ for both neoplastic and non-neoplastic tumours is the skin. Read More

Rom J Morphol Embryol 2015 ;56(2 Suppl):827-32

Department of Dermatology, University of Medicine and Pharmacy of Craiova, Romania;

Unlabelled: Trichoepithelioma is part of the adnexal carcinomas. It is a benign, small tumor, usually under a centimeter in diameter, which develops in the basal cells of the hair follicle.

Case Report: We present the case of a 30-year-old female patient, from rural area, which was hospitalized in the Clinic of Dermatology, Emergency County Hospital, Craiova, Romania, in March 2015, for the presence of a skin tumor, with round-oval shape, 0. Read More

Pan Afr Med J 2015 8;21:19. Epub 2015 May 8.

Dermatological Department, Hassan II University Hospital, Fes, Morocco.

Indian J Dermatol 2015 Jul-Aug;60(4):394-6

Department of Dermatology, PGIMER, Dr. RML Hospital, New Delhi, India.

Trichoepitheliomas (TEs) are benign cutaneous tumors that occur either as solitary non-familial or multiple familial. We report a case of multiple familial trichoepithelioma (MFT) in a 55-year-old female patient and her son who came with complaints of single ulcerated mass involving the left nasolabial fold and cheek. She had multiple papules and nodules all over the face and neck since 25 years. Read More

Int J Dermatol 2016 Mar 28;55(3):270-7. Epub 2015 Jul 28.

Division of Dermatology, Department of Medicine, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa.

Background: Trichoepithelioma (TE) is a benign adnexal neoplasm derived from basal cells in the hair follicle. Solitary TE occurs sporadically as opposed to the multiple familial variant that presents as an autosomal dominant genodermatosis. The solitary variant can be confused with basal cell carcinoma both clinically and histologically. Read More

Appl Immunohistochem Mol Morphol 2016 07;24(6):414-21

Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany.

Although basal cell carcinomas (BCC) show typical histomorphologic features, they sometimes remain difficult in distinction from benign adnexal skin tumors of follicular origin like trichoepithelioma (TE) or trichoblastoma (TB). Consequently, an immunohistochemical marker panel separating described entities would be helpful in clinical routine. Thus, we stained 22 skin lesions (BCC, TE, and TB) against β-catenin, CK20, E-cadherin, p40, and p63. Read More

Int J Trichology 2015 Apr-Jun;7(2):80-1

Department of Ophthalmic Plastics Surgery, L. V. Prasad Eye Institute, Hyderabad, Telangana, India.

Solitary trichoepithelioma of the eyelid is a very rare tumor, which needs to be differentiated from basaloid epithelioma and basal cell carcinoma. Diagnosis is based on clinical and histopathological examination. We present a case of an eyelid trichoepithelioma presenting as a long standing nodule with associated dermatochalasis. Read More