Optimal Timing of Surgical Excision in Pediatric Pilomatricoma: Association between Clinicopathological Features and Cosmetic Outcomes

Abstract

Background: The treatment of choice for pilomatricomas is surgical excision; however, data for the optimal timing of treatment and cosmetic outcomes are limited. Objective: This study aimed to investigate the optimal timing of treatment in pilomatricomas by considering clinicopathological findings and cosmetic outcomes. Methods: Seventy-three pilomatricomas patients aged ≤15 years were retrospectively reviewed. Patients were classified into early excision (disease duration ≤12 months, group A) and delayed excision groups (disease duration >12 months, group B). Tumor characteristics, and histopathological features with evolutionary stages were assessed. Cosmetic outcomes were evaluated by the Modified Vancouver Scar Scale (MVSS), 5-point patient satisfaction score, and complication rates. Results: Group A showed better cosmetic outcomes than group B in the MVSS (1.53±1.22 vs. 3.68±1.84), 5-point patient satisfaction score (4.08±0.89 vs. 3.18±1.01), and complication rates (11.8% vs. 36.4%), respectively (p<0.05). Secondary anetoderma, tent sign, calcification, and late regressive stage (evolutionary stage IV) were more common in group B, (p<0.05). Moreover, evolutionary stages showed a positive correlation with mean MVSS (r=0.670, p<0.05). Conclusion: Early excision (disease duration ≤12 months) provides superior cosmetic outcomes compared to delayed procedures. Early recognition, diagnosis, and management for pediatric pilomatricomas is important to improve overall cosmetic outcomes. (Ann Dermatol 32(2) 93∼100, 2020

Ultrasonographic features of a histologically confirmed pilomatricoma in a dog

“…19 Another human study described 44 pilomatricomas, and reported a significative blood flow with colour Doppler ultrasonography in 22 cases, without any difference from other subcutaneous tumours. 22 Doppler signal detection in pilomatricoma was also noted by other authors [24][25][26][27] ; however, it seems that the presence of a blood flow within the soft tissue content of the mass could be consistent with a pilomatricoma, but absence of this feature cannot rule out this entity. The presence of several blood vessels on histology correlates with ultrasound findings, and the pathogenesis of this hypervascularisation is still unknown.…”

“…In our case, a moderate blood flow at the periphery and inside the mass was detected, without any distinct pattern. The presence of a fluid component, reported in several human studies, 17,21,24,27 reflects cystic degeneration and could be caused by the inflammatory response to the release of keratinised debris, mimicking the presence of a foreign body. In our case, a cystic fluid component was also noted as well as a hypoechoic peripheral rim.…”

“…3,11,12,14 In humans, pilomatricoma is a benign disease that is uncommon, more frequent in children 17 and considered widely underdiagnosed due to the lack of histological analysis of subcutaneous swelling in humans. [16][17][18][19][20][21][22][23][24][25][26][27] Resection with wide margins is the treatment of choice because of the local secondary inflammation, aesthetic reasons and possible malignant transformation. 28 Malignant pilomatricoma (called pilomatrix carcinoma) is unfrequently reported, 26,29−31 but is locally very aggressive and has a metastatic rate between 10% and 16%.…”

“…16,17 Several publications have also assessed the ultrasonographic appearance of pilomatricoma in humans. [15][16][17][18][19][20][21][22][23][24][25][26][27] In dogs, there are also a few reports of the radiographic, 1,3,11,13,14 computed tomographic, 2,4,11 MRI 12 and scintigraphic 1 features of pilomatricoma, and one case report describing the ultrasonographic aspect of metastasis from malignant pilomatricoma. 2 However, in contrast to the human literature, there is no previous report of the ultrasonographic features of a histologically confirmed pilomatricoma in dogs.…”

“…In humans, pilomatricoma is a benign disease that is uncommon, more frequent in children 17 and considered widely underdiagnosed due to the lack of histological analysis of subcutaneous swelling in humans 16–27 . Resection with wide margins is the treatment of choice because of the local secondary inflammation, aesthetic reasons and possible malignant transformation 28 .…”