Corneal erforation casused by eyelid margin trichilemmal carcinoma: A case report

Corneal erforation casused by eyelid margin trichilemmal carcinoma: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case report Corneal erforation casused by eyelid margin trichilemmal carcinoma: A case report Liying Zhang, Zhirong Lin, Huping Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.421/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Trichilemmal carcinoma (TLC) is a rare malignant adnexal tumor predominantly affecting the scalp, eyelids, neck and face of the elderly. Here, we firstly report a rare case of corneal perforation caused by TLC grown in eyelid margin. Case presentation: A 68-year-old female presented with two months history of unprovoked redness, pain and blurred vision in the left eye. On slit-lamp examination, a 1×2mm aseptic corneal perforation embedded by iris prolapsed was noted. After excluding other causes through examinations and case history inquiry, we speculated that the severe MGD and subsequent BKC might be the cause. In order to prevent the ulcer enlargement and intraocular infection, the patient was treated with penetrating keratoplasty immediately. However, a terrible phenomenon has aroused our concern that several small nodules gradually developed on the eyelid margin, accompanied with bleeding, burst and madarosis postoperatiely. The biopsy revealed the eyelid was involved by TLC and then the lesionectomy was performed immediately. There was no evidence of local recurrence and metastasis during 1 year follow-up. Conclusions: The involvement of eyelid margin by TLC, and subsequent BKC and corneal perforation were very rare and it has not been reported yet. The concomitant BKC can be gradually healed after rectifying eyelid margin by total excision of TLC. It is very important to offer careful follow-up to all patients. Internal Medicine Specialties Eyelid margin trichilemmal carcinoma Blepharokeratoconjunctivitis Corneal perforation Figures Figure 1 Figure 2 Background Trichilemmal carcinoma (TLC) is a rare malignant adnexal tumor predominantly affecting the scalp, eyelids, neck and face of the elderly. It is a large, solitary, multilobulated lesion that usually originates from the external hair sheath. The involvement of eyelid margin by TLC and subsequent blepharokeratoconjunctivitis (BKC) have not been reported yet. Here, we firstly report the case of corneal perforation caused by a TLC grown in eyelid margin. Case Presentation A 68-year-old female presented with two months history of redness, pain and blurred vision in the left eye. Slit-lamp examination revealed that left upper eyelid was slight keratinization and had several aberrant lashes, meibomian gland openings got clogged, the conjunctival was congestions and edema. In addition, diffused corneal epithelial punctate defect and neovascularization, especially an 4×3mm irregular corneal epithelial defect was noted at temporal cornea. The most serious observation was a 1×2mm aseptic corneal perforation existed in the central cornea, which had led to iris incarceration (figure 1A). Patients had not been performed eye surgery, also denied the history of ocular trauma, immune-related disorders and excluded other eye diseases. After excluding other causes through examinations and case history inquiry, we speculated that the rough eyelid margin might be the cause of persistent corneal epithelial defect, neovascularization and perforation by repeatedly rubbing the ocular surface. We did some routine examinations to exclude common causes of eyelid infections including: mites, bacterial or viral infection，and non-infectious causes，such as allergic blepharositis and seborrheic blepharositis, etc., but all the results were “negative”. Hence, we speculated that the severe MGD might be the cause of the blepharitis. In order to prevent the ulcer enlargement and intraocular infection, the patient was treated with a penetrating keratoplasty immediately. The size of graft was 7.5mm and bandage contact lens was put on, and all the operation course was successful. At 2 months later, the graft remained clear and no serious complications occurred. However, a terrible phenomenon aroused our concern that several small nodules gradually developed on the rough eyelid margin, accompanied with bleeding, burst and madarosis (figure 1B). Subsquently, we did a biopsy of the eyelid margin, and it revealed an infiltrative, lobulated tumor composed of large, polygonal, clear cells with eccentric nuclei which was differentially diagnosed as TLC (figure 2). Eventually, the cause for changes of eyelid margin came to light and the corneal perforation was caused by TLC inducing the keratinization of eyelid margin. Then the lesionectomy was performed immediately. After that, the patient was transferred to the oncology department for further general examination, and no metastasis was found. Because the characteristic of TLC was rarely metastasizes and low recurrence, the oncologist advised that this patient did not need to get systemic chemoradiotherapy for now. At follow-up 1 year later, there was no evidence of local recurrence and metastasis, and the corneal graft was transparent and no rejection (figure 1C, D). Discussion and Conclusions In 1976, Headington firstly described TLC as a histologically invasive, cytologically atypical clear cell neoplasm of adnexal keratinocytes that is in continuity with the epidermis and/or follicular epithelium[ 1 ]. It often occurs on the sun-exposed skin of the elderly[ 2-4 ], especially affects 40-year-old and older groups[ 5 ], without gender pre-dilection[ 3 ]. Dailey et al reported the TLC growth in the eyelid margin for the first time[ 2 ], however, the involvement of the eyelid margin and the subsequent corneal perforation is rarely reported and the pathogenesis of TLC is not known clearly. Previous studies have postulated that the actinic damage[ 6 ], transformation from benign trichilemmoma[ 7 ] or long term low dose irradiation[ 8 ] could be the etiology of TLC. Histologically, TLC is charecterised by single, exophytic nodular appearance, measuring less than 2cm in diameter, and sometimes it complicates ulceration and keratosis[ 1 , 7 , 8 ]. Microscopically, TLC usually demonstrates proliferative lobules centrered on pilosebaceous , composed of polygonal clear cells and has high-grade mitotic potential[ 4 , 5 , 7 ]. But in this case we noted several diffuse nodules, ulcerations on the upper eyelid margin, and was poorly circumscribed. There was no change in the palpebral conjunctiva. TLC are often confused with other skin cancer, such as clear cell basal cell carcinoma(BCC), squamous cell carcinoma(SCC), trichilemmoma, and malignant proliferating trichilemmal tumors(PTT)[ 1 , 9 ] yet can be differentially diagnosed based on their growth pattern and histopathology. TLC has a benign clinical course, and there is no evidence of recurrence after complete excision[ 7 , 10 ]. Billingsley[ 3 ] and Tze Foon Lai[ 10 ] recommended Mohs micrographic surgery as the treatment to ensure complete surgical excision. Besides, full dose irradiation can be also applied to treat TLC. The concomitant BKC can be gradually healed after total excision. It is very important to offer careful follow-up to all patients. In the early stage of this case, the clinical manifestations of TLC was not apparent. Eyelid margin only showed slight keratinization and roughness, and there was no ulcers or bleeding, it confused us. We excluded common causes of blepharositis, and did not realize it was rare tumor until the ulcer lesions appeared. The involvement of eyelid margin by TLC was very rare and it has not been reported yet. Conjunctival and corneal involvement was considered to be the sequel of BKC, and it affected both the meibomian gland and the ocular surface, leading to keratitis, corneal thinning or perforation, vascularization and scarring. Both mediating chronic inflammatory and rectifying eyelid margin were important in the treatment of BKC. Abbreviations BKC: Blepharokeratoconjunctivitis TLC: Trichilemmal carcinoma BCC: Basal cell carcinoma SCC: Squamous cell carcinoma PTT : Proliferating trichilemmal tumors Declarations Ethics approval and consent to participate This case report was approved by the “Ethics Committee of Xiamen University affiliated Xiamen Eye Center”, and written informed consent was obtained from patient. Consent for publication This patient consent to publish the image of eye and other results of her medical examination in this manuscript or paper which may be published in your journal. Availability of data and materials The corresponding author (Huping Wu) had full access to all the data in this study and takes responsibility for the integrity of the data. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors’ contributions All authors have read and approved the manuscript. Specifically, LZ designed this study, performed the literature search, and wrote the manuscript. Both ZL and HW designed this study. Acknowledgements Not applicable. Contributor Information Liying Zhang, Email: [email protected] . Zhirong Lin, Email: [email protected] . Huping Wu, Email: [email protected] . References Headington JT: Tumors of the hair follicle. A review . Am J Pathol 1976, 85 (2):479-514. Dailey JR, Helm KF, Goldberg SH: Tricholemmal carcinoma of the eyelid . Am J Ophthalmol 1993, 115 (1):118-119. Billingsley EM, Davidowski TA, Maloney ME: Trichilemmal carcinoma . Journal of the American Academy of Dermatology 1997, 36 (1):107-109. Song MG, Min HG, Jung SY, Yang JM, Lee ES: Trichilemmal carcinoma with a cutaneous horn . The British journal of dermatology 2000, 143 (3):646-647. Swanson PE, Marrogi AJ, Williams DJ, Cherwitz DL, Wick MR: Tricholemmal carcinoma: clinicopathologic study of 10 cases . Journal of cutaneous pathology 1992, 19 (2):100-109. Misago N, Tanaka T, Kohda H: Trichilemmal carcinoma occurring in a lesion of solar keratosis . The Journal of dermatology 1993, 20 (6):358-364. Reis JP, Tellechea O, Cunha MF, Baptista AP: Trichilemmal carcinoma: review of 8 cases . Journal of cutaneous pathology 1993, 20 (1):44-49. Chan KO, Lim IJ, Baladas HG, Tan WT: Multiple tumour presentation of trichilemmal carcinoma . British journal of plastic surgery 1999, 52 (8):665-667. Lee JH, Shin YW, Oh YH, Lee YJ: Trichilemmal carcinoma of the upper eyelid: a case report . Korean journal of ophthalmology : KJO 2009, 23 (4):301-305. Lai TF, Huilgol SC, James CL, Selva D: Trichilemmal carcinoma of the upper eyelid . Acta Ophthalmol Scand 2003, 81 (5):536-538. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-421","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case report","associatedPublications":[],"authors":[{"id":7363,"identity":"b2e1ed9f-c6d6-48c7-8488-06a6dca8907a","order_by":1,"name":"Liying Zhang","email":"","orcid":"","institution":"Xiamen University Affiliated Xiamen Eye Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liying","middleName":"","lastName":"Zhang","suffix":""},{"id":7364,"identity":"b07f8cf4-895e-4f89-836d-541a8d37eab0","order_by":2,"name":"Zhirong Lin","email":"","orcid":"","institution":"Xiamen University Affiliated Xiamen Eye Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhirong","middleName":"","lastName":"Lin","suffix":""},{"id":7365,"identity":"9f557c4c-107a-4199-a6ed-6c24a8478fbe","order_by":3,"name":"Huping Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACHiA2YGBgY28/+CChooYELXw8Z5INHpw5RqwWIJCTSDCTfNjCTFiDwY3cY9IFBXfs2hgS0ioSG9gY+Nu7EwhoyUuTnmHwLLmN4eCxG4k7ZBgkzpzdgFeL2Y0cM2keg8PJbIwNaTcSz7AxGEjkEquFmcGsILGNmXgtdmxsDGYMRGmxP/PG2HqGweEENh6eZImEM8d4CPpFsj3H8HbBn8P28vOfH/z4o6JGjr+9F78WEADFRWIDlMNDUDlMiz1RKkfBKBgFo2BkAgAiDEbH50DC4gAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-3401-5257","institution":"Xiamen University Affiliated Xiamen Eye Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Huping","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2019-02-27 17:41:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.421/v1","doiUrl":"https://doi.org/10.21203/rs.2.421/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":178738,"identity":"6a3e0460-9c26-4442-8fb0-911deb840111","added_by":"auto","created_at":"2019-11-25 14:14:40","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":169914,"visible":true,"origin":"","legend":"Ocular surface findings. (A) Clinical photographs at the first visit. The left upper eyelid was slight keratinization and had several aberrant lashes. Meibomian gland openings got clogged. The conjunctival was congestions and edema. In addition, diffused corneal epithelial punctate defect and neovascularization, especially an 4×3mm irregular corneal epithelial defect was noted at temporal cornea. The most serious was a 1×2mm aseptic corneal perforation existed in the central cornea, and the subsequent iris incarceration. (B) Clinical photographs of eyelid at the second month postoperatiely. Several small nodules accompanied with bleeding, burst and madarosis on the left eyelid margin. (C, D) Clinical photographs showed that there was no evidence of local recurrence and metastasis, and the corneal graft was transparent and no rejection after total excision 1 year later.","description":"","filename":"Figure1Re.jpg","url":"https://assets-eu.researchsquare.com/files/d0f3fab2-68bf-492f-9b13-097ec1330ba6/v1/Figure 1 - Re.jpg"},{"id":178740,"identity":"5556216c-1300-42cb-98c5-3ae523f317a5","added_by":"auto","created_at":"2019-11-25 14:14:40","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":155199,"visible":true,"origin":"","legend":"Histological section demonstrating infiltrative lobules of clear cells composed of large, polygonal, clear cells with eccentric nuclei. (Haematoxylin-eosin stain; magnification×200).","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/d0f3fab2-68bf-492f-9b13-097ec1330ba6/v1/figure 2.jpg"},{"id":13466115,"identity":"957c1380-6748-4496-9293-aa091de1aeac","added_by":"auto","created_at":"2021-09-16 20:49:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":594871,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-421/v1/f8fb9cd7-7c5b-4545-a2f5-06eafb5a3077.pdf"},{"id":178737,"identity":"63e97c5c-22f1-4add-ab60-783c66135984","added_by":"auto","created_at":"2019-11-25 14:14:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":2694889,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklist.pdf","url":"https://assets-eu.researchsquare.com/files/d0f3fab2-68bf-492f-9b13-097ec1330ba6/v1/CARE checklist.pdf"}],"financialInterests":"","formattedTitle":"Corneal erforation casused by eyelid margin trichilemmal carcinoma: A case report","fulltext":[{"header":"Background","content":"\u003cp\u003eTrichilemmal carcinoma (TLC) is a rare malignant adnexal tumor predominantly affecting the scalp, eyelids, neck and face of the elderly. It is a large, solitary, multilobulated lesion that usually originates from the external hair sheath. The involvement of eyelid margin by TLC and subsequent blepharokeratoconjunctivitis (BKC) have not been reported yet. Here, we firstly report the case of corneal perforation caused by a TLC grown in eyelid margin.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 68-year-old female presented with two months history of redness, pain and blurred vision in the left eye. Slit-lamp examination revealed that left upper eyelid was slight keratinization and had several aberrant lashes, meibomian gland openings got clogged, the conjunctival was congestions and edema. In addition, diffused corneal epithelial punctate defect and neovascularization, especially an 4\u0026times;3mm irregular corneal epithelial defect was noted at temporal cornea. The most serious observation was a 1\u0026times;2mm aseptic corneal perforation existed in the central cornea, which had led to iris incarceration (figure 1A). Patients had not been performed eye surgery, also denied the history of ocular trauma, immune-related disorders and excluded other eye diseases. After excluding other causes through examinations and case history inquiry, we speculated that the rough eyelid margin might be the cause of persistent corneal epithelial defect, neovascularization and perforation by repeatedly rubbing the ocular surface. We did some routine examinations to exclude common causes of eyelid infections including: mites, bacterial or viral infection，and non-infectious causes，such as allergic blepharositis and seborrheic blepharositis, etc., but all the results were \u0026ldquo;negative\u0026rdquo;. Hence, we speculated that the severe MGD might be the cause of the blepharitis. In order to prevent the ulcer enlargement and intraocular infection, the patient was treated with a penetrating keratoplasty immediately. The size of graft was 7.5mm and bandage contact lens was put on, and all the operation course was successful. At 2 months later, the graft remained clear and no serious complications occurred. However, a terrible phenomenon aroused our concern that several small nodules gradually developed on the rough eyelid margin, accompanied with bleeding, burst and madarosis (figure 1B). Subsquently, we did a biopsy of the eyelid margin, and it revealed an infiltrative, lobulated tumor composed of large, polygonal, clear cells with eccentric nuclei which was differentially diagnosed as TLC (figure 2). Eventually, the cause for changes of eyelid margin came to light and the corneal perforation was caused by TLC inducing the keratinization of eyelid margin. Then the lesionectomy was performed immediately. After that, the patient was transferred to the oncology department for further general examination, and no metastasis was found. Because the characteristic of TLC was rarely metastasizes and low recurrence, the oncologist advised that this patient did not need to get systemic chemoradiotherapy for now. At follow-up 1 year later, there was no evidence of local recurrence and metastasis, and the corneal graft was transparent and no rejection (figure 1C, D).\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eIn 1976, Headington firstly described TLC as a histologically invasive, cytologically atypical clear cell neoplasm of adnexal keratinocytes that is in continuity with the epidermis and/or follicular epithelium[\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e]. It often occurs on the sun-exposed skin of the elderly[\u003ca href=\"#_ENREF_2\"\u003e2-4\u003c/a\u003e], especially affects 40-year-old and older groups[\u003ca href=\"#_ENREF_5\"\u003e5\u003c/a\u003e], without gender pre-dilection[\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e]. Dailey et al reported the TLC growth in the eyelid margin for the first time[\u003ca href=\"#_ENREF_2\"\u003e2\u003c/a\u003e], however, the involvement of the eyelid margin and the subsequent corneal perforation is rarely reported and the pathogenesis of TLC is not known clearly. Previous studies have postulated that the actinic damage[\u003ca href=\"#_ENREF_6\"\u003e6\u003c/a\u003e], transformation from benign trichilemmoma[\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e] or long term low dose irradiation[\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e] could be the etiology of TLC. Histologically, TLC is charecterised by single, exophytic nodular appearance, measuring less than 2cm in diameter, and sometimes it complicates ulceration and keratosis[\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e, \u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e, \u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e]. Microscopically, TLC usually demonstrates proliferative lobules centrered on pilosebaceous , composed of polygonal clear cells and has high-grade mitotic potential[\u003ca href=\"#_ENREF_4\"\u003e4\u003c/a\u003e, \u003ca href=\"#_ENREF_5\"\u003e5\u003c/a\u003e, \u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e]. But in this case we noted several diffuse nodules, ulcerations on the upper eyelid margin, and was poorly circumscribed. There was no change in the palpebral conjunctiva.\u003c/p\u003e\n\u003cp\u003eTLC are often confused with other skin cancer, such as clear cell basal cell carcinoma(BCC), squamous cell carcinoma(SCC), trichilemmoma, and malignant proliferating trichilemmal tumors(PTT)[\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e, \u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e] yet can be differentially diagnosed based on their growth pattern and histopathology.\u003c/p\u003e\n\u003cp\u003eTLC has a benign clinical course, and there is no evidence of recurrence after complete excision[\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e, \u003ca href=\"#_ENREF_10\"\u003e10\u003c/a\u003e]. Billingsley[\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e] and Tze Foon Lai[\u003ca href=\"#_ENREF_10\"\u003e10\u003c/a\u003e] recommended Mohs micrographic surgery as the treatment to ensure complete surgical excision. Besides, full dose irradiation can be also applied to treat TLC. The concomitant BKC can be gradually healed after total excision. It is very important to offer careful follow-up to all patients.\u003c/p\u003e\n\u003cp\u003eIn the early stage of this case, the clinical manifestations of TLC was not apparent. Eyelid margin only showed slight keratinization and roughness, and there was no ulcers or bleeding, it confused us. We excluded common causes of blepharositis, and did not realize it was rare tumor until the ulcer lesions appeared. The involvement of eyelid margin by TLC was very rare and it has not been reported yet. Conjunctival and corneal involvement was considered to be the sequel of BKC, and it affected both the meibomian gland and the ocular surface, leading to keratitis, corneal thinning or perforation, vascularization and scarring. Both mediating chronic inflammatory and rectifying eyelid margin were important in the treatment of BKC.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBKC: Blepharokeratoconjunctivitis\u003c/p\u003e\n\u003cp\u003eTLC: Trichilemmal carcinoma\u003c/p\u003e\n\u003cp\u003eBCC: Basal cell carcinoma\u003c/p\u003e\n\u003cp\u003eSCC: Squamous cell carcinoma\u003c/p\u003e\n\u003cp\u003ePTT : Proliferating trichilemmal tumors\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case report was approved by the \u0026ldquo;Ethics Committee of Xiamen University affiliated Xiamen Eye Center\u0026rdquo;, and written informed consent was obtained from patient.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis patient consent to publish the image of eye and other results of her medical examination in this manuscript or paper which may be published in your journal.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author (Huping Wu) had full access to all the data in this study and takes responsibility for the integrity of the data.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the manuscript. Specifically, LZ designed this study, performed the literature search, and wrote the manuscript. Both ZL and HW designed this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributor Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiying Zhang, Email: [email protected].\u003c/p\u003e\n\u003cp\u003eZhirong Lin, Email: [email protected].\u003c/p\u003e\n\u003cp\u003eHuping Wu, Email: [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHeadington JT: \u003cstrong\u003eTumors of the hair follicle. A review\u003c/strong\u003e. \u003cem\u003eAm J Pathol \u003c/em\u003e1976, \u003cstrong\u003e85\u003c/strong\u003e(2):479-514.\u003c/li\u003e\n\u003cli\u003eDailey JR, Helm KF, Goldberg SH: \u003cstrong\u003eTricholemmal carcinoma of the eyelid\u003c/strong\u003e. \u003cem\u003eAm J Ophthalmol \u003c/em\u003e1993, \u003cstrong\u003e115\u003c/strong\u003e(1):118-119.\u003c/li\u003e\n\u003cli\u003eBillingsley EM, Davidowski TA, Maloney ME: \u003cstrong\u003eTrichilemmal carcinoma\u003c/strong\u003e. \u003cem\u003eJournal of the American Academy of Dermatology \u003c/em\u003e1997, \u003cstrong\u003e36\u003c/strong\u003e(1):107-109.\u003c/li\u003e\n\u003cli\u003eSong MG, Min HG, Jung SY, Yang JM, Lee ES: \u003cstrong\u003eTrichilemmal carcinoma with a cutaneous horn\u003c/strong\u003e. \u003cem\u003eThe British journal of dermatology \u003c/em\u003e2000, \u003cstrong\u003e143\u003c/strong\u003e(3):646-647.\u003c/li\u003e\n\u003cli\u003eSwanson PE, Marrogi AJ, Williams DJ, Cherwitz DL, Wick MR: \u003cstrong\u003eTricholemmal carcinoma: clinicopathologic study of 10 cases\u003c/strong\u003e. \u003cem\u003eJournal of cutaneous pathology \u003c/em\u003e1992, \u003cstrong\u003e19\u003c/strong\u003e(2):100-109.\u003c/li\u003e\n\u003cli\u003eMisago N, Tanaka T, Kohda H: \u003cstrong\u003eTrichilemmal carcinoma occurring in a lesion of solar keratosis\u003c/strong\u003e. \u003cem\u003eThe Journal of dermatology \u003c/em\u003e1993, \u003cstrong\u003e20\u003c/strong\u003e(6):358-364.\u003c/li\u003e\n\u003cli\u003eReis JP, Tellechea O, Cunha MF, Baptista AP: \u003cstrong\u003eTrichilemmal carcinoma: review of 8 cases\u003c/strong\u003e. \u003cem\u003eJournal of cutaneous pathology \u003c/em\u003e1993, \u003cstrong\u003e20\u003c/strong\u003e(1):44-49.\u003c/li\u003e\n\u003cli\u003eChan KO, Lim IJ, Baladas HG, Tan WT: \u003cstrong\u003eMultiple tumour presentation of trichilemmal carcinoma\u003c/strong\u003e. \u003cem\u003eBritish journal of plastic surgery \u003c/em\u003e1999, \u003cstrong\u003e52\u003c/strong\u003e(8):665-667.\u003c/li\u003e\n\u003cli\u003eLee JH, Shin YW, Oh YH, Lee YJ: \u003cstrong\u003eTrichilemmal carcinoma of the upper eyelid: a case report\u003c/strong\u003e. \u003cem\u003eKorean journal of ophthalmology : KJO \u003c/em\u003e2009, \u003cstrong\u003e23\u003c/strong\u003e(4):301-305.\u003c/li\u003e\n\u003cli\u003eLai TF, Huilgol SC, James CL, Selva D: \u003cstrong\u003eTrichilemmal carcinoma of the upper eyelid\u003c/strong\u003e. \u003cem\u003eActa Ophthalmol Scand \u003c/em\u003e2003, \u003cstrong\u003e81\u003c/strong\u003e(5):536-538.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Eyelid margin trichilemmal carcinoma; Blepharokeratoconjunctivitis; Corneal perforation","lastPublishedDoi":"10.21203/rs.2.421/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.421/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: Trichilemmal carcinoma (TLC) is a rare malignant adnexal tumor predominantly affecting the scalp, eyelids, neck and face of the elderly. Here, we firstly report a rare case of corneal perforation caused by TLC grown in eyelid margin. Case presentation: A 68-year-old female presented with two months history of unprovoked redness, pain and blurred vision in the left eye. On slit-lamp examination, a 1×2mm aseptic corneal perforation embedded by iris prolapsed was noted. After excluding other causes through examinations and case history inquiry, we speculated that the severe MGD and subsequent BKC might be the cause. In order to prevent the ulcer enlargement and intraocular infection, the patient was treated with penetrating keratoplasty immediately. However, a terrible phenomenon has aroused our concern that several small nodules gradually developed on the eyelid margin, accompanied with bleeding, burst and madarosis postoperatiely. The biopsy revealed the eyelid was involved by TLC and then the lesionectomy was performed immediately. There was no evidence of local recurrence and metastasis during 1 year follow-up.\nConclusions: The involvement of eyelid margin by TLC, and subsequent BKC and corneal perforation were very rare and it has not been reported yet. The concomitant BKC can be gradually healed after rectifying eyelid margin by total excision of TLC. It is very important to offer careful follow-up to all patients.","manuscriptTitle":"Corneal erforation casused by eyelid margin trichilemmal carcinoma: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2019-03-03 12:50:11","doi":"10.21203/rs.2.421/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e93d8db3-67dc-490e-adf9-cf1aa02279f8","owner":[],"postedDate":"March 3rd, 2019","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":940,"name":"Internal Medicine Specialties"}],"tags":[],"updatedAt":"","versionOfRecord":[],"versionCreatedAt":"2019-03-03 12:50:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-421","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-421","version":["v1"]},"buildId":"k-LANOkFix9YAoV-Y-q_i","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}