A clinical review of 209 pilomatricomas,☆☆

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Abstract

Background: Pilomatricomas have a wide variety of clinical characteristics and are often misdiagnosed. This can result in extensive surgery for an essentially benign condition. Objective: The purpose of this study was to define the clinical and histologic spectrum of these tumors to aid diagnosis. Methods: Two hundred nine cases were analyzed retrospectively with regard to age at presentation, site, size, and physical appearance. Results: 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. Conclusion: Careful clinical examination and a high index of suspicion results in an accurate diagnosis, appropriate treatment, and the avoidance of unnecessarily extensive surgery. (J Am Acad Dermatol 1998;39:191-5.)

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PATIENTS AND METHODS

Case histories of patients with pilomatricoma who were seen between 1976 and 1996 were examined. The age, site, size, physical appearance at examination, and preoperative diagnosis were noted. Histologic evidence confirmed the diagnosis. Additional cases were detected by review of hospital pathology reports and subsequent examination of clinical notes. In total, 209 cases were studied, 125 in female patients and 84 in male patients.

Age at examination

The youngest patient was 18 months of age, and the oldest patient was 86 years of age (Fig. 1).

. Male and female age distribution.

The peak age of presentation was 5 to 15 years in female patients and up to 5 years in male patients. There was a second peak in adults between 50 and 65 years of age. The ratio of female to male patients was 1.5:1 overall but was 2.5:1 in patients less than 20 years of age. Most patients (53%) had a tumor for no longer than 6 months. However, the time to diagnosis

DISCUSSION

Our study has confirmed the wide range of presentation of pilomatricomas. Although many pilomatricomas resemble an epidermoid cyst, others can mimic a variety of malignant tumors.

More than one half of the tumors were located on the head, but only 9.5% of them originated on the scalp, perhaps surprising for a tumor whose origin is from hair follicles. Noguchi et al.10 suggested that the distribution of pilomatricoma corresponds to the density of hair follicles at a particular site. The hairy

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