Practical Skin Pathology: A Diagnostic Approach by Patterson James W

Author:Patterson, James W [Patterson, James W.]
Language: eng
Format: epub
ISBN: 978-1-4557-3827-4
Publisher: Elsevier Health Sciences
Published: 2013-03-22T22:00:00+00:00

Pilomatricoma

Clinical Features: Pilomatricoma, also termed calcifying epithelioma of Malherbe, is a tumor that displays differentiation toward the follicular matrix. It has a bimodal age distribution, with the greatest peak in children and young adults and a second peak in individuals older than 50 years of age. It presents as a deep, slow-growing, cystic nodule that is firm and sometimes rock hard on palpation. It most often arises on the head and neck but is sometimes found in other locations.66–69 Surface erosion is occasionally evident. Multiple pilomatricomas may be seen in myotonic dystrophy,70 and, as mentioned elsewhere, cysts showing features of pilomatricoma are identified in patients with Gardner syndrome.71 A possible association with Turner syndrome is less clear.72

Changes suggesting an intermediate-grade lesion (atypical or proliferating pilomatricoma) can be seen (see microscopic description). There is also a pilomatrix carcinoma, which is discussed in a later section. Occasionally, the deep location of a pilomatricoma may create a resemblance to an enlarged lymph node, prompting the use of fine needle aspiration biopsy. Diagnosis can be made with this technique,73 although the cytologic atypia often seen in specimens obtained by this method may lead to an erroneous diagnosis of metastatic carcinoma. Local excision is the recommended therapy for these lesions.

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