Treatment of Pilomatricoma

Complete surgical excision is the standard treatment for pilomatricoma, providing cure without recurrence in most cases. 1

Diagnosis and Clinical Presentation

Pilomatricoma (also known as calcifying epithelioma of Malherbe) is a benign skin tumor that develops from cells of the pilar matrix 1
Most commonly presents as a firm, irregular subcutaneous mass, often on the head and neck region, particularly in the pediatric population 2
The lesion typically appears as a hard, slow-growing, subcutaneous tumor, sometimes associated with pain, inflammation (18%), or abscess/ulceration (11%) 2

Complete surgical excision is the primary treatment of choice for pilomatricoma 1, 2
Traditional wide local excision has been the standard method of management, ensuring complete removal of the tumor 3
For facial lesions, complete excision including the overlying skin may be necessary in some cases 2

Incision and curettage (I&C) technique has been proposed as an alternative with improved cosmetic outcomes, particularly for pediatric patients 3
- This involves making a small incision over or near the lesion in a discrete location and removing the tumor piecemeal 3
- Studies show no recurrences with this technique in follow-up periods ranging from 1-10 years 3, 4
- Parents report high satisfaction with cosmetic results using this approach 3

For facial lesions (53% of cases): Direct surgical approach with or without skin resection 2
For parotid region lesions (21% of cases): An indirect approach via a parotidectomy-like incision may be used 2
For neck lesions (21% of cases): Direct surgical approach 2
For scalp lesions (5% of cases): Direct surgical approach 2

Preoperative diagnosis is crucial for appropriate management, though pilomatricomas are frequently misdiagnosed 5
CT scan can be helpful for diagnosis, especially for tumors located in the parotid region 2
Spontaneous regression is never observed, making surgical intervention necessary 2
Malignant transformation to pilomatrical carcinoma is rare but possible, highlighting the importance of complete excision and histological confirmation 1
Recurrence is rare after complete surgical excision 5

Pilomatricoma has a predilection for the pediatric population, with a mean age of 4.5 years in one study 2
Female predominance has been observed 3
Multiple lesions can occur in some patients (approximately 12%) 2
For children, minimally invasive approaches like incision and curettage may be preferred for improved cosmetic outcomes, particularly for facial lesions 3

Routine post-operative follow-up should be conducted 4-6 weeks after surgery 3
Long-term follow-up may be beneficial to monitor for rare recurrences 3, 4
Annual skin examination is recommended for patients with constitutional mismatch repair deficiency syndrome (CMMRD) who have an increased risk of developing pilomatricoma and other skin neoplasms 6