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Review of pediatric head and neck pilomatrixoma
Yehuda Schwarz1, Jacob Pitaro1, Sofia Waissbluth1
1Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
Pediatric head and neck pilomatrixomas are common benign skin tumors often misdiagnosed. Increased awareness of their typical presentation can improve diagnosis and management of these lesions.
Area of Science:
- Dermatology
- Pediatric Oncology
- Head and Neck Surgery
Background:
- Pilomatrixoma is a benign skin tumor typically found in the head and neck.
- These tumors are rarely malignant but frequently misdiagnosed.
- This review focuses on pilomatrixoma in children.
Purpose of the Study:
- To review the clinical characteristics of head and neck pilomatrixomas in pediatric patients.
- To highlight diagnostic challenges and suggest a management approach.
Main Methods:
- A systematic review of 10 databases was conducted.
- 17 studies involving 318 pediatric patients were included.
- Study quality was assessed by two independent reviewers.
Main Results:
- The study included 318 pediatric patients (age 3 months–17 years), with a 1.65:1 female to male ratio.
- Most lesions were in the head (75%) and neck (25%).
- Clinical diagnostic accuracy averaged 43%, despite classical features; surgical excision had low recurrence.
Conclusions:
- Head and neck pilomatrixoma in children presents typically but has low diagnostic accuracy.
- Increased awareness of clinical appearance can improve diagnosis.
- A management algorithm for suspected pilomatrixoma is proposed.
Introduction:
Pilomatrixoma is a benign skin tumor, which is commonly found in the head and neck region. It usually presents as an isolated lesion and rarely undergoes malignant transformation. It is not uncommon for these tumors to be misdiagnosed.
Objective:
To review the clinical characteristics of head and neck pilomatrixomas in the pediatric population.
Methods:
A systematic review was completed by searching ten databases to identify studies reporting findings on pilomatrixoma in the pediatric population. Eligible articles were independently assessed for quality by two authors.
Results:
A total of 17 studies met the inclusion criteria totaling 318 pediatric patients. The age of diagnosis ranged from 3 months to 17 years of age. The female to male ratio was 1.65:1. In 14 articles, in which pilomatrixoma was located in the head and neck region, 76 (25%) lesions were found in the neck while 229 (75%) were present in the head region. Three articles exclusively described ophthalmologic pilomatrixoma. Even though pilomatrixoma presents with classical features, the clinical diagnostic accuracy when confronting this lesion averaged 43%. The definitive treatment was surgical excision with a very low recurrence rate.
Conclusion:
Head and neck pilomatrixoma in the pediatric population has a typical presentation with a low clinical diagnostic accuracy. Awareness of this lesion and its clinical appearance can improve its diagnosis. We hereby suggest a management algorithm for suspected pilomatrixoma.
