Title : Pilomatricoma in pediatric patients: Clinical features, diagnosis, and management

Pilomatricoma is a benign cutaneous tumor originating from the hair matrix cells. It is considered one of the most common superficial skin tumors in children and adolescents. Pilomatricoma typically presents as a superficial, mobile, firm, slow-growing, and painless mass. The lesion most commonly occurs in the head and neck region, although it may also be found on the upper and lower extremities. Most cases are solitary, with lesion sizes generally ranging from 0.5 to 3 cm. Pilomatricomas may occur at any age, with a peak incidence during the first two decades of life. Malignant transformation is exceedingly rare.

The etiopathogenesis of pilomatricoma is not completely understood. Clinically, the lesion may be associated with normal overlying skin or demonstrate a bluish-red discoloration. Characteristic findings such as the “tent sign” and “teeter-totter sign” may assist in diagnosis, although they are not universally present. The differential diagnosis includes dermoid cyst, epidermal inclusion cyst, lipoma, hemangioma, ossified hematoma, osteoma cutis, foreign body reaction, enlarged lymph nodes, and other benign soft tissue tumors. Imaging studies are generally not required but may be useful when the diagnosis is uncertain. Fine-needle aspiration cytology may provide diagnostic clues in selected cases; however, definitive diagnosis is established through histopathological examination. Histologically, pilomatricoma demonstrates characteristic basaloid cells and eosinophilic anucleate shadow (ghost) cells, frequently accompanied by calcification, foreign-body giant cell reaction, and occasionally ossification. Complete surgical excision remains the gold standard of treatment. Surgical removal is generally curative and associated with excellent cosmetic and functional outcomes. Recurrence is uncommon and is usually related to incomplete excision.

In our retrospective study, 10 patients (3.5-17 years old) whose histopathology report indicated pilomatricoma between 2020 and 2025 were analyzed. Demographic characteristics of the patients, symptoms, location, size and volume of lesion were evaluated. The mean age of the 10 cases was 12.1±5.3, and 8 (80%) of the cases were male. In terms of lesion localization; 1 case were located in the head, 2 cases in the neck, 1 case in the trunk, 5 cases in the upper extremities and 1 case in the lower extremities. When the dimensions of the lesions were examined; 1 (10%) was smaller than 1 cm, 6 (60%) were between 1-2 cm, and 3 (30%) were larger than 2 cm. The largest lesion measured 2x1.5x0.7 cm. The average volume of the lesions was 1.3±5.3 cm3. Multiple lesions were not observed. No recurrence was detected in any of the cases.

In conclusion, pilomatricoma is a relatively common benign skin tumor that should be taken into consideration in the differential diagnosis of superficial or subcutaneous masses, particularly in pediatric patients. Early recognition, accurate histopathological diagnosis, and complete surgical excision provide excellent outcomes.

I am Y.Doruk Bilgili. I completed my medical education at Demiroğlu Bilim University between 2009 and 2015. I completed my residency in pediatric surgery at Zonguldak Bulent Ecevit University between 2016 and 2022. I worked at Siverek State Hospital and Bandirma Training and Research Hospital between 2022 and 2024. I have been working as Head of Pediatric Surgery Department at Bandirma Onyedi Eylul University since April 2024. I am doing research on circumcision, perioperative anxiety and appendicitis.