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Pilomatricoma in children: common but often misdiagnosed
N A Roche1, S J Monstrey, G E Matton
1Department of Plastic and Reconstructive Surgery, University Hospital Gent, Belgium. nathalie.roche@ugent.be
Abstract:
A pilomatricoma, also known as pilomatrixoma or calcifying epithelioma of Malherbe, is a benign skin tumor arising from the hair follicle matrix. This tumor is common in children and young adults, especially in the head and neck region. However, pilomatricomas are frequently misdiagnosed or not recognized. The history is typical of a slowly enlarging mass, irregularly contoured, it is fixed to the skin but slides freely over the, underlying tissues, often with a discolouration which varies from red to purple-bluish. Ultrasound examination, MRI-scan and fine-needle aspiration can be helpful if the diagnosis is uncertain. Spontaneous regression has never been observed and malignant degeneration is very rare. Surgical excision with clear margins is the treatment of choice, otherwise recurrence may occur due to incomplete resection.
Insights
Pilomatricomas are benign skin tumors originating from hair follicles, often misdiagnosed in children and young adults. Complete surgical excision is crucial to prevent recurrence, as spontaneous regression or malignant changes are rare.
Area of Science:
- Dermatology
- Oncology
Background:
- Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign skin neoplasm.
- It originates from the hair follicle matrix and is most common in pediatric and young adult populations, particularly affecting the head and neck.
- Pilomatricomas are frequently misdiagnosed or overlooked due to their variable presentation.
Observation:
- Clinical presentation includes a slowly enlarging, irregularly contoured mass fixed to the skin but mobile over deeper tissues.
- Skin discoloration ranging from red to purple-bluish may be present.
- Diagnostic aids like ultrasound, MRI, and fine-needle aspiration can assist in uncertain cases.
Findings:
- Spontaneous regression of pilomatricomas has not been documented.
- Malignant transformation of these tumors is exceedingly rare.
Implications:
- Accurate diagnosis is essential, as pilomatricomas can be mistaken for other skin lesions.
- Complete surgical excision with adequate margins is the recommended treatment to ensure definitive removal and prevent recurrence.
- Incomplete resection is a significant risk factor for tumor recurrence.
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