Trichilemmal Carcinoma is characterized in the literature as a locally problematic skin-adnexal carcinoma that is entirely amenable to successful management by surgery alone, and that recurrences and metastatic lesions are not reported. 2 cases treated by the same surgeon are presented that demonstrated local recurrence in spite of agressive MOHS excision. The two patients are very different in  demographics, and one patient demonstrated distant recurrence. Both patients required very extensive reconstruction.

The pathology of skin-adnexal carcinomas is discussed, and the literature reviewed.