Pilomatricoma or calcifying epithelioma of malherbe. A pediatric review of 89 cases B. Pulvermacker, D. Seroussi, R.Haddad, M. Mitrofanoff

Annales de Chirurgie Plastique Esthétique 2007: 52: 39–42

This article points out the high frequency of benign tumours in the pediatric population. Eighty nine pilomatricomas were reviewed consisting of sixty-eight females, average age 7 ranging from 7 months to 15 years. The average size of the tumors was 1 cm. (ranging from 5 mm to 3.5 cm) and located mainly in the head and neck region (71%). In some cases, multiple pilomatricomas were observed in the same patient. The diagnoses are essentially clinical and it is more difficult in ulcerating cases. The authors found that Ultrasound can be of benefit for the parotid area. The authors have not observed any correlation of pilomatricomas with Steinert or Gardner syndrome as found in previous literature. The treatment of choice is surgery.

The authors mentioned the possibility of malignant pilomatricoma. It is a rare entity and the diagnosis is made by the histologocal findings. It has the potential of recurrence and distant metastases. The authors should have explained that these malignancies were observed in elderly patients, and must be differentiated from the aggressive pilomatricoma described by Marrogi (Am J Dermatopathol 1992) and observed also in children and young adults.

The important thing in my opinion is that every pîlomatricoma should be removed. We must also take into account the risk of infection and the risk of increasing volume and cuteanous involvement which then requires a large cutaneous excision leading to a bigger scar and in addition, every pilomatricoma must be sent to the pathologists for examination. The excision must be total including a thin envelope because recurrence is frequent in cases of insufficient removal.

PATRICK DINER