Volume 28, No.1, April 2021 The Gulf Journal of Dermatology and Venereology 52 CASE REPORT An enlarging keratotic verrucous papule on the vulva Lamiaa Hamie, MD, Mazen Kurban, MD, Ossama Abbas, MD, Nelly Rubeiz, MD Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon ABSTRACT Trichilemmoma as a benign neoplasm with diferentiation toward pilosebaceous follicular epithelium, or outer root sheath. Although benign in nature, its importance lies in its association with Cowden syndrome. In which it is found to be associated with multiple types of tumors. Also, it needs to be diferentiated from other more aggressive cutaneous tumors, such as trichilemmal carcinoma. Clinically, they present as well-defned, smooth, asymptomatic papules or verrucous papules. Which may occur either as a solitary lesion or in some cases as multiple lesions. They are commonly located in the head and neck region. We are herewith presenting a case of solitary trichilemmoma occurring in a rather unusual location. KEYWORDS: Trichilemmoma, adnexal tumor, vulva INTRODUCTION Headington and French in 1962, frs described trichilemmoma as a benign neoplasm with diferentiation toward pilosebaceous follicle. Although it is benign in nature, its signifcance lies in its association with Cowden syndrome. In which, it is found to be associated with multiple other types of tumors. Also, it needs to be diferentiated from other more aggressive cutaneous tumors, such as trichilemmal carcinoma. Clinically, it may present as a solitary or multiple skin-colored papules disributed typically over the central face. Desmoplasic variant of trichilemmoma is known to develop in the genital area and can also present as a secondary neoplasm in nevus sebaceous. The clinical diferentials of trichilemmomas includes verruca vulgaris and other hair follicle or epidermal tumors. The diagnosis can only be Correspondence: Dr. Ossama Abbas, Professor, Department of Dermatology, American University of Beirut Medical Center, Riad El Solh/ Beirut 1107 2020, Beirut, Lebanon, P.O.Box 11-0236 , Email : ossamaabbas2003@yahoo.com, Tel.: +961-1-350000, ext. 7915, Fax : +961-1-745320 confrmed by hisopathological examination. Herein, we are presenting a case of biopsy confrmed solitary trichilemmoma occurring in a rather unusual location. CASE REPORT A 72-year-old woman presented to the dermatology clinic with a verrucous papule on the right vulva of 2 weeks duration. She was known to have lichen sclerosus of the perineum, controlled with topical clobetasol and barrier creams. Medical hisory was pertinent for diabetes, hypertension, and dyslipidemia. Physical examination revealed a 4 mm keratotic verrucous papule over the right vulvar area (Fig. 1). No other lesions were identifed. Biopsy specimen revealed a folliculo-centric lobular tumor composed of monomorphous