A clinical review of 209 pilomatricomas.

Abstract

Pilomatricomas have a wide variety of clinical characteristics and are often misdiagnosed. This can result in extensive surgery for an essentially benign condition. The purpose of this study was to define the clinical and histologic spectrum of these tumors to aid diagnosis. Two hundred nine cases were analyzed retrospectively with regard to age at presentation, site, size, and physical appearance. Pilomatricomas appear at any age, with peak presentation bimodally in the first and sixth decade. Their most common site is the head and neck. Presentation is of a hard nodule, either deeply subcutaneous and invisible or superficial with possible erosion through the skin surface. This may lead to a false diagnosis of malignancy or of an epidermoid cyst. An association with myotonic dystrophy has been confirmed, as is the rare occurrence of malignant transformation. Careful clinical examination and a high index of suspicion results in an accurate diagnosis, appropriate treatment, and the avoidance of unnecessarily extensive surgery.