Trichoblastic carcinoma: a systematic review of an aggressive follicular neoplasm with an emphasis on Mohs micrographic surgery in management

Abstract

Trichoblastic carcinoma (TC) is a rare and aggressive adnexal tumor with a high potential for metastasis and frequent misdiagnosis due to its histopathologic similarity to basal cell carcinoma (BCC). This systematic review consolidates current knowledge on TC, including its clinical presentation, histopathology, treatment approaches, and outcomes. TC most commonly presents on the face and scalp as a nodular lesion, often with ulceration. Histologically, it is characterized by basaloid islands, nuclear palisading, and high mitotic activity. Differentiating TC from BCC is crucial, as TC exhibits a significantly higher metastatic potential. Surgical excision remains the primary treatment, with Mohs micrographic surgery offering better recurrence-free outcomes. Emerging therapies, including targeted treatments and immunotherapy, have shown potential in select cases. However, due to the lack of standardized management guidelines, further research is needed to refine diagnostic criteria, optimize treatment strategies, and improve patient outcomes.