Departments of Ophthalmology and Pathology, 12 de Octubre Hospital, Complutense University, Madrid, Spain
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A 79-year-old woman presented with an eyelid mass below the eyebrow. It was first noticed by the patient 7 months before and had slowly increased in size and had become itchy. Physical examination revealed an ulcerated, desquamative, nonumbilicated, nodular mass arising from the inner third of the right upper eyelid (Fig. 1). It was firm, well-demarcated, and measured 12 mm in diameter and 10 mm in height, without free edge involvement (to 0.9 cm). The remainder of the ocular examination was normal. With a clinical diagnosis of basal cell carcinoma, it was completely excised under local anesthesia, with 3-mm safety margins of normal appearing tissue. Wound repair by means of a skin flap advanced from the temporal side was performed.A histopathologic diagnosis of trichoblastoma was made based on the presence of a well-circumscribed, symmetrical mass occupying dermal and upper areas of subcutaneous tissue and closely related to the overlying epidermis (Fig. 2, top). The tumor consisted of nests and cords of cells with an interlacing pattern included in an abundant, delicate, fibrocytic, fibrillary stroma. A follicular germ-like structure was also seen (Fig. 2, bottom). Immunohistochemistry showed isolated Merkel cells positive for chromogranin A.