Pilomatrix carcinoma of the vulva

Pilomatrix Carcinoma: Report of Two Cases of the Head and Review of the Literature

BACKGROUND

Pilomatrix carcinoma (PC) is a rare skin tumor arising from hair follicle matrix cells. It is locally aggressive with a high rate of local recurrence after surgical excision. Few cases in the literature have been described and the management is not well defined.

OBJECTIVES

The aim of this study was to present two cases of PC located on the head and review the relevant literature about epidemiology, clinical and dermoscopic evaluation, characteristics of local and distant metastases, local recurrence rate and management of this rare skin tumor.

METHODS

We consulted databases from PubMed, Research Gate and Google Scholar, from January 2012 to November 2022. We reviewed the literature and reported two additional cases.

RESULTS

We selected 52 tumors in middle-aged to older patients located mostly on the head. Dermoscopy evaluation was rarely performed in the pre-operative diagnostic setting. The most definitive treatment was wide local excision, but local recurrences were common. In total, we observed 11 cases of recurrences and 9 patients with locoregional or distant metastases. Four patients received adjuvant radiotherapy, two patients needed chemotherapy and local cancer therapy and one patient received radiochemotherapy.

CONCLUSION

Our reports and the review of the literature can provide a better awareness and management of this rare tumor.

Vulvar Pilomatrix Carcinoma: Morphologic and Molecular Features

Pilomatrix carcinoma (PC) is a rare malignant variant of pilomatrixoma, a skin adnexal tumor originating from hair matrix cells. It is most often located in the head, neck region, upper back and upper extremities. PC has a locally aggressive behavior but metastasis only occur in 10% of cases. Mutations in CTNNB1, the encoding gene of beta-catenin, have been found in both pilomatrixoma and PC, but other molecular alterations are unknown. The authors present a case of PC in the clitoris, the third known reported case located on the external genitalia. The tumor followed an unusual clinical course with the development of multiple metastases. Next-generation sequencing analysis of the tumor identified, in addition to a characteristic CTNNB1 mutation, pathogenic mutations in PTEN, PIK3CA, and ARID1A, which could explain the aggressive course of the disease. The diagnostic criteria of PC and the differential diagnoses of this unusual tumor in the genital area are discussed.

Pilomatrix carcinoma of the male breast: a case report

Pilomatrix carcinoma (PC) is a rare skin adnexal neoplasm derived from piliferous follicles, usually occurring in the head and neck region. An optimal treatment for PC has not yet been established, while surgery with wide margins is recommended, with radiation therapy (RT) and chemotherapy improving the curative effect. Location of this tumor in the breast is exceedingly rare, especially for a male. We now report an unusual case of a 53-year-old male who presented with 2 palpable masses in the right breast, which had been removed surgically about 4 and a half years prior, but recurred after 7 months. Ultrasonography revealed 2 irregular low-echo masses with a well-defined boundary, and computed tomography (CT) showed 2 soft tissue masses in subcutaneous tissue of the right breast. The tumors were completely removed without RT and chemotherapy. After about 4 years' follow-up, the patient remains free of local recurrence and metastasis. To the best of our knowledge, only 2 cases of PC in the breast region have been reported, but were female.