Periocular Pilomatrixoma: A Retrospective Analysis of 16 Cases

Pilomatrixoma of the Periorbital Region: A Retrospective Review

PURPOSE

Pilomatrixoma is a benign cutaneous adnexal tumor that differentiates toward hair follicle cells. It infrequently occurs in the periorbital region. In the periorbital area, it is often located in the upper eyelid and eyebrow region. Periorbital pilomatrixoma is often misdiagnosed clinically and is less common than other benign skin tumors. In this retrospective review, we evaluate the demographic, clinical, and histopathological data of patients with periorbital pilomatrixoma, treated from 2010 to 2023.

METHODS

A retrospective analysis of periorbital pilomatrixoma cases treated during a period of 13 years was performed. Deidentified data in relation to the age at surgical excision, gender, location, size, histopathological features, treatment, and recurrence were collected. All histological slides were reviewed by an attending histopathologist.

RESULTS

A total of 77 cases of periorbital pilomatrixoma were diagnosed by histopathological examination and treated from 2010 to 2023. A slight female preponderance (56%) was noted, and the majority of cases (52%) were presented in the first 2 decades of life. The left periorbital region was involved in 45.5% of cases, and 54.5% in the right. The upper lid was the most affected site. Two cases of recurrence were reported. No malignant transformation was noted.

CONCLUSIONS

Pilomatrixoma is an uncommon benign periorbital tumor, commonly misdiagnosed clinically. Ophthalmologists and surgeons should suspect pilomatrixoma in the periorbital region, especially in children or young adults. Complete surgical excision is curative, and recurrence is rare.

Periocular pilomatrixoma in childhood: Clinical feature and differential diagnosis

PURPOSE

To explore the clinical characteristics, imaging features, and differential diagnosis of periocular pilomatrixoma in children and provide evidence for clinical diagnosis and treatment.

METHODS

Retrospective analysis of the clinical characteristics, preliminary diagnosis, imaging features, treatment, and follow-up of the cases of pediatric periocular pilomatrixoma treated at our hospital.

RESULTS

A total of 59 patients from 4 months to 13 years of age (median age 4 years) were collected; 18 cases (30.51%) were misdiagnosed as other diseases in preliminary diagnoses. Seven cases underwent computed tomography (CT) examination, with CT value ranging from 63.4 Hounsfield Units (HU) to 952.0 HU (median value 151.0 HU). Six cases underwent magnetic resonance imaging (MRI) examination; two patients underwent an enhanced scan. The results showed that the rim of the lesion was enhanced, but the contents were not enhanced. All patients underwent surgical treatment. No recurrence was found from 1 month to 5 years of follow-up.

CONCLUSIONS

Periocular pilomatrixoma is a relatively common tumor in children, which can easily be misdiagnosed clinically as other diseases, such as sebaceous and dermoid cysts. Although not generally recommended, CT can be of significant value in the diagnosis of pilomatrixoma. MRI is of little value in the diagnosis of this disease. If CT images show high or density, the possibility of pilomatrixoma should be considered.

Pilomatrixoma in a child mimicking a ruptured epidermal cyst clinically and histopathologically: Case report

Introduction and importance

Pilomatrixoma is a superficial benign skin tumor that originates from the matrix cells of the hair follicles. It presents more frequently during the first two decades of life and usually involves the head and neck, most often in the eyelid or eyebrow area.

Case presentation

We present a case of pilomatrixoma, which appeared at the age of 14 years with history of recurrent inflammation and discharge mimicking a ruptured epidermal cyst.

Discussion

Pilomatrixomas are often confused clinically with other benign masses, encountered in the clinical practice more frequently like dermoid cysts and epidermal inclusion cysts. The rate of accurate preoperative diagnosis ranges between 0%–30% and the correct diagnosis can be established only after excision and histopathological examination. Our case demonstrates an atypical presentation of pilomatrixoma as an epidermal inclusion cyst.

Conclusion

Ophthalmologists and ocular pathologists should be aware of the atypical presentation of pilomatrixomas to ensure early accurate diagnosis and curative treatment.

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Pilomatrixoma is a benign skin tumor with typical histopathological appearance.

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Pilomatrixoma is often confused clinically with an epidermal cyst.

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Accurate diagnosis and complete excision of pilomatrixoma is essential.

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Our case demonstrates the pitfall in diagnosing pilomatrixoma.

Quadri dermatologici della regione perioculare

Un piccolo atlante in 36 immagini

A new case of the pilomatrixoma rare in the preauricular region and review of series of cases

Pilomatrixoma is considered a rare benign tumor arising from the hair follicle, most common in the head and neck region, but it is rarely diagnosed on a clinical basis. This report describes a new case of giant pilomatrixoma in a 36-year-old female patient. The nodule was localized in the preauricular area on the right side, appearing as a slow-growing, fixed, painless, with a hardened consistency, unusual giant (4.5 cm). A cone-beam computed tomography (CBCT) examination showed a slightly hyperdense lesion, and fine-needle aspiration cytology (FNAC) revealed peripheral blood and mononucleated inflammatory cells. After enucleation of lesion, a diagnosis of pilomatrixoma was confirmed. The differential diagnosis of pilomatrixoma is broad, because its characteristics also can be found in other lesions common to the head and neck. Thus, a lesion in the head and neck, adherent to the skin, and well demarcated, mainly in the young and in females, should be suspected as pilomatrixoma.

Pilomatrixoma: A Comprehensive Review of the Literature

INTRODUCTION

Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a superficial benign skin tumor that arises from hair follicle matrix cells. Although pilomatrixomas are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. By reviewing all the literature over the past 10 years, the aims of this article are to analyze the cause, clinical presentation, management, and outcome of pilomatrixoma among children and adults to gain a more complete understanding of this lesion in today's clinical context.

METHODS

A MEDLINE and EMBASE search was conducted from January 2005 to February 2015 using a combination of the terms: "child," "childhood," "adult," and keywords: "pilomatrixoma," "pilomatricoma," and "calcifying epithelioma of Malherbe." A total of 150 articles were reviewed.

RESULTS

The lesions occurred most commonly in the first and second decades (mean age 16 years and 7 months). The commonest presentation was of an asymptomatic, firm, slowly growing, mobile nodule. Only 16% were accurately diagnosed on clinical examination. Imaging in the form of ultrasound, computed tomography, and magnetic resonance imaging has been reported. Pathological diagnosis was achieved through incision, punch, and shave biopsies. Pathological findings are discussed and summarized in this review.

CONCLUSION

Pilomatrixomas are thought to arise from mutation in the Wnt pathway and has been linked to several genetic conditions. It is commonly misdiagnosed preoperatively; however, with better awareness of the lesion, it can be appropriately treated while avoiding unnecessary diagnostic tests. Complete surgical excision with clear margins is almost always curative.

Periocular dermatoses

The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.

Review of pediatric head and neck pilomatrixoma

INTRODUCTION

Pilomatrixoma is a benign skin tumor, which is commonly found in the head and neck region. It usually presents as an isolated lesion and rarely undergoes malignant transformation. It is not uncommon for these tumors to be misdiagnosed.

OBJECTIVE

To review the clinical characteristics of head and neck pilomatrixomas in the pediatric population.

METHODS

A systematic review was completed by searching ten databases to identify studies reporting findings on pilomatrixoma in the pediatric population. Eligible articles were independently assessed for quality by two authors.

RESULTS

A total of 17 studies met the inclusion criteria totaling 318 pediatric patients. The age of diagnosis ranged from 3 months to 17 years of age. The female to male ratio was 1.65:1. In 14 articles, in which pilomatrixoma was located in the head and neck region, 76 (25%) lesions were found in the neck while 229 (75%) were present in the head region. Three articles exclusively described ophthalmologic pilomatrixoma. Even though pilomatrixoma presents with classical features, the clinical diagnostic accuracy when confronting this lesion averaged 43%. The definitive treatment was surgical excision with a very low recurrence rate.

CONCLUSION

Head and neck pilomatrixoma in the pediatric population has a typical presentation with a low clinical diagnostic accuracy. Awareness of this lesion and its clinical appearance can improve its diagnosis. We hereby suggest a management algorithm for suspected pilomatrixoma.

Uncommon benign tumour of the skin: infraorbital pilomatricoma

Pilomatricoma is a relatively rare tumour of the skin derived from primitive basal cells of epidermis that differentiate into hair matrix cells. It comprises approximately 1% of all benign skin tumours. The most common sites for pilomatricomas are the head, neck and upper extremities. A 44-year-old woman, admitted to our department, underwent an orthopantomography examination, which revealed a well-circumscribed 1.6×1.4 mm radiopaque mass superimposed between the medial wall of the right maxillary sinus and lateral wall of the nasal cavity. Clinically, it was firm and mobile, and remained attached to the underlying skin when palpated. A cone beam CT scan was performed to ascertain its location and anatomic relations. Subsequently, it was totally excised under local anaesthesia. Histopathological evaluation of the lesion reported it to be a pilomatricoma.