Pilomatricoma in an Octogenarian: A Case Report of an Exceptional Late-Life Presentation

BACKGROUND Pilomatricoma, also known as Malherbe's calcifying epithelioma, is a benign adnexal tumor originating from hair follicle matrix cells and occurs predominantly in children and young adults. Its presentation in an older adult is exceptionally rare and can pose diagnostic challenges. We report a rare case of pilomatricoma in an 86-year-old patient. CASE REPORT We report the case of an 86-year-old man who presented with a tender, subcutaneous cyst on the right scalp. The lesion had been evolving for several months, enlarging from approximately 5 cm to 8 cm. His medical history included multiple comorbidities: coronary artery disease, insulin-requiring type 2 diabetes mellitus, advanced chronic kidney disease, hypertension, dyslipidemia, and chronic obstructive pulmonary disease. Initial biopsy suggested pilomatricoma without malignant features; however, clinicopathological discordance and tumor progression raised suspicion of malignancy. Owing to significant anesthetic risk, initial management consisted of close surveillance. Following the onset of bleeding, surgical excision was performed. Histopathological analysis confirmed a benign pilomatricoma with clear margins. Postoperative recovery was uneventful, and follow-up was scheduled. CONCLUSIONS Giant pilomatricoma can present atypically in older patients, mimicking malignancy and leading to diagnostic uncertainty. This case underscores the importance of considering this diagnosis despite age and rapid growth, and supports complete surgical excision for definitive diagnosis and management.