Clinical features and surgical management of pilomatrixoma in children: a 332-case retrospective study

Analyze clinical characteristics and surgical outcomes of pediatric pilomatrixoma.

A retrospective analysis was performed on the clinical data of 332 pediatric patients diagnosed with pilomatrixoma, who were admitted to the Shanxi Provincial Children's Hospital between January 2017 and December 2024. This cohort included a total of 350 tumors, with 11 cases presenting with 2 tumors, 2 cases with 3 tumors, and 1 case with 4 tumors. The analysis encompassed various parameters, including sex, age, disease course, tumor site, maximum diameter, ultrasound characteristics, and treatment modalities.

Patients aged 4 months-17 years (male:female = 1:1.26; 147 M:185F), peak incidence 0-2 years. Tumors primarily facial (71.4%, n = 250), then neck (10.3%), head (8.9%), limbs (8.3%), and torso (1.1%). The tumors adhere to the skin to varying degrees, but are mobile over the underlying base; 52.3% (n = 183) had overlying skin discoloration; 0.9% (n = 3) ulcerated. Ultrasound predominantly showed hypoechoic lesions (82.6%, n = 289); echogenicity positively correlated with disease course (P < 0.05). Tumor diameter ranged 0.3-3.6 cm; most enlarged progressively (3 stable). All underwent complete surgical excision with cosmetic closure and postoperative anti-scar therapy. No recurrences or hypertrophic scarring occurred during follow-up. Histopathology confirmed diagnosis (basophilic basaloid cells, shadow cells, calcification).

Pediatric pilomatrixoma shows slight female predominance, highest incidence under age 2, and favors the face. Hypoechoic ultrasound appearance is typical; size and echogenicity increase with longer duration. Early surgical intervention (within 6 months) minimizes incision length. Complete excision with cosmetic closure and anti-scar therapy achieves excellent aesthetic outcomes without recurrence.