Modern Plastic Surgery, 2012, 2, 54-57 http://dx.doi.org/10.4236/mps.2012.23014 Published Online July 2012 (http://www.SciRP.org/journal/mps) Unusual Invasıon of Trichilemmal Umors: Two Case Reports Mehtap Karamese, Ahmet Akatekin, Malik Abaci, Zekeriya Tosun, Mustafa Keskin Reconstructive and Aesthetic Surgery, Department of Plastic, Selcuklu Faculty of Medicine, Selcuk University, Konya, Turkey. Email: mehtapef@yahoo.com, {ahmetakatekin, maablaicki}@gmail.com, {ztosun, drmkeskin}@hotmail.com Received April 4 th , 2012; revised May 7 th , 2012; accepted June 6 th , 2012 ABSTRACT Background: Proliferating trichilemmal tumors are slow-growing lobulated masses most commonly found on the scalp of elderly women. Due to the locally invasive nature of the lesion, the treatment is complete excision of the tumor with tumor-free margins. Methods: We present two cases of trichilemmal tumors that exhibited aggressive local invasion across tissue planes. The first case had dural invasion, which needed dural reconstruction. The second case had muscle invasion, which required wide resection. Results: Sixteen months after their surgeries, the patients are in good health without any recurrence of tumors. Conclusion: Trichilemmal tumors may exhibit aggressive local invasion across tissue planes and even penetrate intracranially, causing considerable morbidity and mortality. The possibility of dural and muscle invasion must be kept in mind in order to achieve successful treatment results. A close clinical follow-up is judicious for detecting recurrences or metastases. Keywords: Trichilemmal Tumor; Dural Invasion 1. Introduction Proliferative trichilemmal tumors are rare neoplasms that develop from the external root sheath of a hair follicle. These tumors arise mainly in areas of dense hair follicle concentration: 90% occur on the scalp [1]. The usual cli- nical presentation is a subcutaneous cystic nodule. Pa- tients most often present with a solitary lesion, but mul- tiple lesions are encountered at times. A trichilemmal tu- mor has a benign clinical course, but exhibits a malignant and invasive histological appearance [2]. Dural invasions or muscle invasions of trichilemmal tumors have been very rarely reported. However, here were port a dural in- vasion and a muscle invasion in two cases of trichilem- mal tumors. 2. Case Report No. 1 A 49-year-old man presented with a mass in his scalp. He had burned his scalp with hot water 25 years ago. He first noticed this mass four years ago. The lesion had been growing rapidly for the previous six months. Upon ex- amination, the lesion was 8 × 6 × 5 cm in size with irregular margins and superficial erosion (Figure 1). No other regional lymphadenopathy was detected. The brain computerized tomography revealed a mass with dural invasion (Figure 2). A wide excision was performed under general anesthesia. The dura was excised and re- placed with a dural graft by a neurosurgeon. A bone defect was replaced with a split calvarial graft. Scalp reconstruction was done with a bipedicled scalp flap. Histopathological diagnosis of the mass determined it was a malign proliferative trichilemmal tumor. The local oncology committee did not recommend chemotherapy. At the 16-month follow-up, there was no evidence of local recurrence or metastasis (Figure 3) [3]. 3. Case Report No. 2 A 47-year-old man presented with a huge mass on his upper back. He first noticed this mass 10 years ago. The lesion had been growing rapidly for the previous five months. Upon examination, the 16 × 17 cm pain less non-tender mass was palpated on the trapezius muscle (Figure 4). The lesion had occurred spontaneously and was not associated with any history of trauma, and there was no past history of a similar tumor any where on his body. The tumor was not fixed to the underlying bones. Magnetic resonance imaging showed the tumor had infiltrated the underlying muscle with undistinguishable borders (Figure 5). A wide excision of the tumor was performed under general anesthesia. Muscle fibers that had been infiltrated by tumor were excised widely. Re- construction of the defect required a skin graft. The histopathological analysis determined that the tumor was a proliferative trichilemmal tumor. Allcut magrins were Copyright © 2012 SciRes. MPS