Treatment and Pathology
Currently, no medical therapy for pilomatricomas is available. Surgical excision ensuring that the entire mass is removed is the treatment of choice. If the mass is adherent to the overlying skin, an ellipse of skin can also be removed. The excised specimen often has a chalky consistency due to calcifications. Figure 2 shows an intraoperative picture of the lesion.
Figure 2. Specimen after surgical excision.
Definitive diagnosis is made by pathologic examination and detection of pathognomonic ghost cells devoid of nuclei. Hematoxylin and eosin stain of this patient's specimen revealed basaloid cells surrounding foci of ghost cells, as well as basaloid matrix with giant cells (Figures 3-5).
Figure 3. Low-power hematoxylin and eosin stain.
Figure 4. High-power hematoxylin and eosin stain demonstrating ghost cells surrounded by basaloid cells.
Figure 5. High-power hematoxylin and eosin stain demonstrating basaloid matrix with giant cells.
Often, many areas show granulomatous inflammation. Calcification can also be seen surrounding the ghost cells.
Recurrence is usually very low after complete surgical excision in large patient series.[2,3,5,9] It is not necessary to follow patients for a prolonged period, but it is important to educate them on the signs and symptoms of recurrence.
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Cite this: Ian C. Hoppe, Mark S. Granick. A Boy With a Subcutaneous Mass - Medscape - Feb 14, 2012.