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Pilomatrixoma: a common, benign childhood skin tumour
Insights
Pilomatrixomas are common in children but often misdiagnosed, leading to unnecessary surgery. Early diagnosis of these superficial masses is key for successful treatment and avoiding aggressive interventions.
Area of Science:
- Pediatric Dermatology
- Surgical Pathology
- Oncology
Background:
- Pilomatrixoma is a benign skin tumor originating from hair follicle matrix cells.
- It commonly affects children and adolescents, typically presenting as a painless subcutaneous nodule.
Purpose of the Study:
- To review recent clinical experience with pilomatrixoma in children.
- To emphasize the importance of accurate diagnosis to guide appropriate management.
Main Methods:
- Retrospective chart review of 51 histologically confirmed pilomatrixomas in 50 children over an 8-year period.
- Analysis of clinical presentation, diagnostic accuracy, and pathological findings.
Main Results:
- Most pilomatrixomas presented as slow-growing, asymptomatic superficial masses, predominantly on the head and neck (78%).
- Diagnostic accuracy was low, with incorrect referring diagnoses in 94% and preoperative diagnoses in 57% of cases.
- Pathologically, tumors were dermal or subcutaneous, with calcification noted in some; no recurrences were observed after excision.
Conclusions:
- Pilomatrixomas in children are successfully treated with simple excision.
- Variable clinical presentations contribute to diagnostic challenges, highlighting the need for increased awareness and early, accurate diagnosis to prevent unnecessary aggressive surgical interventions.
Objective:
To review recent experience with pilomatrixoma, particularly with respect to diagnosis.
Design:
Chart review for an 8-year period.
Setting:
A university-affiliated children's hospital.
Patients:
Fifty children with 51 histologically proven pilomatrixomas.
Intervention:
Excision of the lesion.
Main Outcome Measures:
Clinical presentation, diagnosis and pathological findings.
Results:
The clinical presentation was typically that of an asymptomatic superficial mass that increased slowly in size and was located in the head and neck (78%) or chest and upper limbs. In one case the mass increased rapidly over 2 weeks and changed in colour from red to purple with areas of pink and tan. The referring diagnosis was incorrect in 94% of cases, and the preoperative diagnosis was incorrect in 57%. Pathologically the tumours were situated in the dermis or subcutaneous tissue. None were cystic, but several had areas of calcification. None of the tumours recurred after excision, but two patients had multiple lesions at different locations and times.
Conclusions:
Pilomatrixomas in children are simple to treat successfully but have variable clinical presentation. Early diagnosis is important so that unnecessary, aggressive surgery can be avoided.