Diagnosis and Clinical Presentation
- Pilomatrixoma presents as a firm, subcutaneous nodule or tumor, typically 0.5-3 cm in size with calcium-like consistency, faceted edges, and blue erythematous overlying skin 1
- These benign tumors develop from the matrix cells of hair follicles and are common in children 1
- Diagnosis is often suspected based on the characteristic clinical presentation, though preoperative diagnosis is accurate in only about 32% of cases 2
- Ultrasound imaging is the optimal diagnostic tool for pilomatrixoma before surgical intervention 2
Surgical Management Options
Standard Surgical Excision
- Complete surgical excision with clear margins is the standard and most widely accepted treatment approach 1, 2
- This approach is curative with very low recurrence rates 3
- Surgical excision is particularly important for definitive histological diagnosis 4
Minimally Invasive Approach
- Incision and curettage (I&C) technique may be considered as an alternative to wide local excision, especially for lesions on cosmetically sensitive areas like the face 5
- This technique involves making a small incision over or near the lesion in a discrete location and removing the tumor piecemeal 5
- Studies have shown excellent cosmetic outcomes with no recurrence in long-term follow-up (mean 6 years) 5
Special Considerations
- Most pilomatrixomas occur on the head and neck region (approximately 67% in some studies) 4
- Multiple or bilateral pilomatrixomas can occur and may present diagnostic challenges 3
- Annual skin examination is recommended for patients with constitutional mismatch repair deficiency syndrome (CMMRD) who have an increased risk of developing pilomatrixoma 6
Postoperative Care and Follow-up
- Routine post-operative follow-up is typically conducted at 4-6 weeks 5
- Recurrence after complete surgical removal is rare 3
Common Pitfalls to Avoid
- Misdiagnosis is common, as pilomatrixomas can mimic other skin conditions including epidermal inclusion cysts, trichilemmal cysts, and other lesions 4
- While experienced surgeons may excise suspected pilomatrixomas without prior imaging, high-resolution ultrasonography can help confirm the diagnosis preoperatively 4
- Most cystic lesions that imitate pilomatrixoma will ultimately require surgical excision regardless of preoperative diagnosis 4