Pilomatricoma, also called Malherbe's calcifying epithelioma, is a benign adnexal neoplasm that originates from hair follicle matrix cells. It most commonly affects children and young adults; presentation in older adults is rare. When pilomatricomas do occur in atypical age groups or grow rapidly to large sizes, they can mimic malignant skin neoplasms and create diagnostic uncertainty. The diagnosis is ultimately histopathological, and complete excision often serves both diagnostic and therapeutic roles.
An 86-year-old man presented with a tender, subcutaneous cyst on the right scalp. The lesion had been present for several months and enlarged from approximately 5 cm to 8 cm during that period. The patient’s medical history included multiple significant comorbidities: coronary artery disease, insulin-requiring type 2 diabetes mellitus, advanced chronic kidney disease, hypertension, dyslipidemia, and chronic obstructive pulmonary disease. These comorbid conditions contributed to an elevated anesthetic and surgical risk profile that influenced initial management decisions.
An initial biopsy was performed and the result was reported as consistent with pilomatricoma without malignant features. Despite this, clinicopathological discordance was noted: the clinical behavior (rapid growth and relatively large size in an elderly patient) raised ongoing concern for possible malignancy. The abstract does not report details such as imaging studies, the biopsy technique used, or specific histologic descriptions beyond the lack of malignant features on the initial specimen.
Because of the patient’s elevated anesthetic risk related to multiple comorbidities, the treating team initially opted for close surveillance rather than immediate surgical excision. During the surveillance period the lesion progressed and ultimately bled, prompting definitive surgical management. The report indicates that excision was performed following the onset of bleeding. The abstract does not provide procedural details such as anesthesia type, margin strategy, reconstructive approach, intraoperative findings, or perioperative medical management.
Excisional histopathology confirmed a benign pilomatricoma with clear margins. The final specimen did not demonstrate malignant features according to the abstract. Postoperatively the patient had an uneventful recovery and follow-up was arranged. The abstract does not specify the duration or schedule of follow-up visits, nor does it include long-term outcome data such as recurrence status after a defined interval.
This case underscores several clinical points:
The source abstract provides a concise summary but omits several potentially relevant details. Not reported in the abstract were specific histologic descriptions of the lesion beyond benign confirmation, imaging or radiologic assessment, the exact biopsy method, operative technique and anesthesia details, margin measurements, and the length or findings of follow-up after surgery. These details would be necessary to fully appraise operative risk mitigation, pathological staging considerations, and long-term outcomes.
This reported case of a large pilomatricoma in an 86-year-old man highlights that benign adnexal tumors of follicular origin can rarely present in advanced age and with rapid growth, creating diagnostic challenges and potential concern for malignancy. In the presence of clinicopathological discordance, progression, or complication such as bleeding, excisional management can provide definitive diagnosis and cure. Clinicians should weigh comorbidity-related anesthetic risks against the potential need for surgical clarification in similar cases.
(Note: The abstract was the source of all facts summarized here. Specific procedural details, imaging findings, microscopic descriptions beyond benign confirmation, and exact follow-up intervals were not reported in the source.)