Pilomatrix Carcinoma In A 4-Year-Old Child With An Unusual Presentation

Area of Science:

• Dermatopathology
• Pediatric Oncology

Background:

• Pilomatrix carcinoma is a rare, aggressive skin neoplasm.
• It is a variant of pilomatrixoma with high recurrence and metastasis risks.

Observation:

• An unusual case of pilomatrix carcinoma in a 4-year-old male child is presented.
• The child had recurrent cheek lesions starting from 1 month of age.
• Initial lesions showed basaloid cells with ghost cells; recurrences exhibited necrosis, infiltration, and lymphovascular invasion.

Findings:

• Histopathological analysis confirmed pilomatrix carcinoma despite initial benign-appearing features.
• Recurrent lesions demonstrated aggressive histological characteristics, including stromal necrosis and lymphovascular invasion.
• The diagnosis was supported by morphological features, despite a lack of marked nuclear pleomorphism.

Implications:

• This case underscores the importance of recognizing aggressive histological features in suspected pilomatrix carcinoma, especially in infants.
• Early and accurate diagnosis is critical for managing this rare pediatric malignancy.
• Continued follow-up is essential due to the high risk of recurrence and metastasis.