<p>A 43 year old was referred with a solitary non-tender slow growing lesion on the temple. Clinically and dermoscopically what is the differential and how would you manage this case?</p>
<p>Your first clinical thought could be a BCC, but what about the dermoscopic appearance?</p>
<p>Dermosocopically the vessels are not as sharp/arborising as one tends to see in a BCC, and what about the multiple medium-large white clods? </p>
<p>As a result of the dermoscopic features I felt a BCC was unlikely so I undertook a 6 mm punch biopsy, the results of which showed a desmoplastic trichoepithelioma, an uncommon benign appendageal tumour. This is the second such lesion I have seen with medium-large white clods. Most appendageal tumours are uncommon, and usually only diagnosed from histology. For more information refer to the relevant PCDS chapter on <a href="http://www.pcds.org.uk/clinical-guidance/appendage-tumours">appendageal tumours</a>. </p>
<p>Images copied with kind permission from South Tees Hospitals NHS Foundation Trust.</p>
