A 72-year-old female presented with two years history for a pruritic plaque on her eyelid. No any other significant finding.

 What is your diagnosis? 

Diagnosis: Trichilemmoma

Trichilemmoma may be either solitary or multiple. Solitary trichilemomma has no characteristic clinical appearance and occasionally measures several centimeters in diameter as this case. 

Histopathologically, this tumor has a lobular pattern and a variable number of tumor cells have the appearance of clear cells owing to their content of glycogen.

In a retrospective study on 7751 ophthalmic specimens at the Henry C. Witelson Ophthalmic Pathology Laboratory and Registry, McGill University, Montreal, 228 benign adnexal tumors were found on the eyelids. Of these, 11 tumors (4.8%) diagnosed as trichilemmoma ¹.

Benign tumours originating from skin appendages of the eyelid are rare and frequently have apocrine or eccrine differentiation. These tumors, particularly those originating from the hair follicle, should be considered in the differential diagnosis of BCC of the eyelid.

Reference:

1. Ozdal PC, Callejo SA, Codere F, Burnier MN Jr. Benign ocular adnexal tumours of apocrine, eccrine or hair follicle origin. Can J Ophthalmol. 2003 Aug;38(5):357-63.