Trichilemmal carcinoma of the lower eyelid in a oculocutaneous albino patient.

TO THE EDITOR: Trichilemmal carcinoma (TLC) is a rare cutaneous adnexal neoplasm deriving from the outer root of the hair follicles. It represents the malignant counterpart of trichilemmoma and occurs as vegetating, often ulcerated or crusted nodule or plaque usually arising in the sun-exposed areas of the elderly population. Head, neck and dorsum of the hand are the most frequently involved sites.1 Oculocutaneous albinism is characterized by the lack of enzyme tyrosinase, essential for the production of melanin. These patients are born with bluish eyes and white hair and skin, and they maintain these features when growing old. They show an increased risk of skin cancer, mainly squamous and basal cell carcinomas.2 We describe the case of a 70-year-old oculocutaneous albino patient that presented with a firm 15x7 mm right lower eyelid nodule (Figure 1). The patient referred that this nodule arose three months before as a little papule and grew very quickly to the actual size. The patient was also affected by psoriasis. The anamnesis revealed an exaggerated sun exposure in the past: the patient worked outdoor as bricklayer in Africa for 30 years. The patient developed several basal and squamous cell carcinomas and his whole face was affected by severe actinic keratoses. We treated the patient with numerous surgical excisions for the tumours and with methyl aminolevulinate-photodynamic therapy for the severe field cancerization of his sun exposed areas. We decided to surgically remove the nodule and we repaired the minus with an advancement flap. Histologically the neoplasia is lobulated, follicole centred, focally in continuity with epidermis.