To describe the clinical presentations and discuss the guidelines for surgical management of pilomatrixoma involving the head and neck in children.Design
A tertiary care center.Patients
Thirty-three patients, with a mean age of 4.5 years, underwent surgical treatment for pilomatrixoma (n=38) between 1989 and 1997.Intervention
All patients were treated surgically. In 34 cases, a direct approach was used to achieve complete removal of the lesion with (n=11) or without (n=23) skin resection. In the remaining 4 cases, an indirect approach via a parotidectomylike incision was used.Results
In 88% of cases, the presenting symptom was a hard, slow-growing, subcutaneous tumor. The lesion was associated with pain and inflammation in 7 cases (18%) and abscess or ulceration in 4 cases (11%). Twenty-nine patients presented with single nodules and 4 presented with multiple occurrences. The lesions were located on the face (cheek, eyelid, or forehead) in 20 cases (53%), on the neck in 8 cases (21%), in the parotid region in 8 cases (21%), and on the scalp in 2 cases (5%).Conclusions
Pilomatrixoma is a rare, benign skin tumor, but practitioners should be aware of its clinical features. Diagnosis is usually easy based on clinical findings, but computed tomographic scan is helpful, especially in cases involving tumors located in the parotid region. Spontaneous regression is never observed. Complete surgical excision, including the overlying skin, is the treatment of choice.