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Letter

Epidermal Cyst on the Face of a Child, Clinically and Dermoscopically Mimicking Pilomatricoma

Author Affiliation(s)

Introduction

We present a case of an epidermal cyst on the face of a child, clinically and dermoscopically mimicking pilomatricoma. Pilomatricoma, also called pilomatrixoma or calcifying epithelioma of Malherbe, is a benign skin tumor and one of the most common causes of superficial head and neck masses in children and young adults [ 1 ] . It usually manifests as a solitary, asymptomatic, firm nodule on the face (especially eyelids and eyebrows), scalp, neck, or arms [ 1 ] . Common differential diagnoses for head and neck pilomatricoma include sebaceous cyst, ossifying hematoma, giant cell tumor, chondroma, dermoid cyst, foreign body reaction, degenerating fibroxanthoma, metastatic bone formation, and osteoma cutis [ 1 ] . Pilomatricoma-like changes have been described in epidermoid cysts in patients with Gardner syndrome [ 1 ] . Surgical excision of the pilomatricoma is the treatment of choice, with wide resection margins to minimize the risk of recurrences [ 2 ] .

Case Presentation

In our case, a 6-year-old girl presented clinically with a preauricular, firm, solitary lesion that had been growing slowly for the 2 months before the first visit ( Figure 1 ). Dermoscopy revealed erythematous border, irregular white structures, and brown-blue central pigmentation ( Figure 2 ).

Figure 1 .

Clinical presentation of a preauricular, firm, solitary lesion on the face of a 6-year-old girl. [Copyright: ©2019 Krtanjek et al.]

Figure 2 .

Dermoscopy image of the lesion (Dermlite 3Gen PRO HR II, Nikon Coolpix). Erythematous surrounding skin, irregular white structures, and brown-blue central pigmentation. [Copyright: ©2019 Krtanjek et al.]

Based on the clinical and dermoscopic examination, the initial diagnosis was pilomatricoma with differential diagnosis of foreign body reaction. After 1 month, the lesion enlarged quickly; therefore, excision was advised. Histopathology report demonstrated a cyst lined by an epidermis-like epithelium including a granular cell layer, filled with laminated keratin, compatible with a diagnosis of epidermal cyst ( Figure 3 ).

Figure 3 .

A cyst lined by an epidermis-like epithelium including a granular cell layer, filled with laminated keratin. [Copyright: ©2019 Krtanjek et al.]

Conclusions

We believe that this is the first report of an epidermal cyst on the face of a child with these dermoscopic features. Given its frequent incidence, this diagnosis should be considered when evaluating similar skin lesions, to avoid unnecessary surgical excision.

References

  1. Usefulness of dermoscopy for the diagnosis of epidermal cyst: the ‘pore’ sign Ghigliotti G, Cinotti E, Parodi A. Clin Exp Dermatol.2014;39(5):649-650.
  2. The diagnosis of pilomatrixoma in children is not as easy as it may seem: a review of 126 cases [in Spanish] Fernández Atuan R, Álvarez García N, González Ruiz Y, Siles Hinojosa A, Rihuete Heras MA, Elías Pollina J. Cir Pediatr.2017;30(1):46-49.

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