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Pilomatricoma

Checked: 13-02-2024 by Rob Adams Next Review: 13-02-2026

Overview

Pilomatricoma's (syn Pilomatrixoma's) are a hamartoma of the hair matrix, and the most common of the hair follicle tumours (1) .

Age - the majority of patients are under 20 when they present, although can arise at any age.
Distribution - mainly the head, neck and upper extremities.
Palpation - a stony hard, deep-seated lesion, 3-30 mm in diameter, with normal overlying skin.
Occasionally lesions arise in older patients when they often grow more rapidly and may occur at atypical sites.
Malignant change is rare and most commonly occurs in large lesions.

Associated conditions

Pilomatricomas may rarely be associated with underlying conditions (2,3).

Lindsay Shaw (consultant paediatric dermatologist at UBHW) advises that 'in practice, it is very unlikely that they will be associated with underlying conditions that are not completely obvious such as Turner's and Rubinstein-Taybi. The association with Gardener's is interesting but actually the risk of colon cancer is not going to be until much later in life.'

Diagnosis

If there is diagnostic uncertainty then use paediatric dermatology advice and guidance initially.

Referral

Referral via eRS to paediatric dermatology can be made for a diagnostic opinion or if there are concerns about underlying conditions. However, referrals requesting excision would be subject to the Benign Skin Lesions Policy and will be returned if prior approval criteria are not met.

Resources

(1) Appendageal tumours (pcds.org.uk)

(2) Childhood pilomatricomas: Associated anomalies - PubMed (nih.gov)

(3) Syndromes associated with multiple pilomatricomas: When should clinicians be concerned? - PubMed (nih.gov)

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