What are pilomatricoma and pilomatrical carcinoma?

Updated: Oct 07, 2019
  • Author: Guy J Petruzzelli, MD, PhD, MBA, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Answer

The classic features of a benign pilomatricoma—pleomorphic basaloid cells accompanied by central areas with keratotic material, shadow or ghost cells, and zones of necrosis with surrounding stromal desmoplasia—suggest a carcinoma rather than a benign neoplasm. 

Features of pilomatrical carcinoma, which are more fulminant and exuberant than those of pilomatricoma, include asymmetry, poor circumscription, large and variably-shaped aggregations of pleomorphic basaloid cells, basaloid cells with vesicular nuclei and prominent nucleoli, atypical mitotic figures, extensive areas of necrosis, ulceration, and infiltrative growth patterns. No single feature is diagnostic of pilomatrical carcinoma and immunohistochemistry does not distinguish benign from malignant pilomatrical neoplasias. 

Pilomatricomal carcinoma has most often been treated with wide surgical excision, although Mohs micrographic surgery has reportedly been effective. Radiation therapy may have a role in the palliation of metastatic pilomatrical carcinoma, which is usually fatal. [140]  (Text reproduced with permission from the Dermatology Online Journal.)


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