IntroductionPilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign skin tumor arising from the outer root sheath cell of the hair follicle. In the pediatric population, this skin neoplasm is relatively common, especially in the head and neck region (1). Despite the fact that pilomatricomas are frequent occurring skin tumors in children, that the history is typical of a slowly growing tumor and that the characteristic clinical appearance is of a superficial hard mass with discoloration, this lesion is often misdiagnosed or not recognized and confused with other skin conditions (2). The treatment however is straightforward : after complete surgical excision, recurrence is unlikely and malignant degeneration is very rare (3).In this article, we present several cases of pilomatricomas with a classical presentation together with a brief review of the literature. We also describe an atypical case : a 1.5-year-old girl with a rapidly growing mass in the face, suggestive for a malignant tumor, in whom the final diagnosis of pilomatricoma was only made after incisional biopsy. Shortly after this surgery she developed a recurrence and complete surgical excision was performed with an uneventful postoperative follow-up.
Pilomatricomas with Typical PresentationA 6-year old girl was referred with a slowly growing mass on the left elbow. The tumor had been present for 2 months, was adherent to the overlying skin, but mobile from underlying tissues, with a purple discoloration (Fig. 1). A pilomatricoma was suspected because of this typical appearance and complete excision was performed. Pathological examination confirmed the clinical diagnosis and the postoperative follow-up during 1 year was uneventful.A 7-year old girl presented with a slowly growing, painless tumor on the right cheek (Fig. 2). The mass had been present for several months. Clinical examination revealed a mobile, red-bluish irregular mass with calcifications in the right preauricular region, fixed to the ulcerated overlying skin. A pilomatricoma was suspected based on the clinical signs and the lesion was excised. The pathology report confirmed the diagnosis and the postoperative follow-up during 18 months was uneventful.A 20-year old girl was seen with a pendulous tumor at the back of the left thigh (Fig. 3). The mass had been present for 1 year, growing slowly. At clinical examination, a purple tumor was seen with irregular nodes, hard at palpation but mobile from the underlying tissues. A pilomatricoma was diagnosed because of the typical signs and excision with primary closure was performed. The clinical diagnosis was confirmed by histological examination and follow-up during 1 year was uneventful.A 5-year old girl consulted for a mass in the right preauricular region. This had been present for 7 months and was slowly growing. A painless, hard 1.5 cm lesion was palpated, mobile from the underlying tissues with irregular calcifications (Fig. 4). Pilomatricoma was suspected and the lesion was excised ; the pathology report confirmed the...