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| CASE REPORT |
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| Year : 2014 | Volume
: 6
| Issue : 1 | Page : 21-22 |
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Three different dermoscopic view of three new cases with pilomatrixoma
Erhan Ayhan1, OC Ertugay2, R Gundogdu3
1 Department of Dermatology, Zile State Hospital, Tokat, Turkey
2 Department of Otorhinolaryngology, Zile State Hospital, Tokat, Turkey
3 Department of General Surgery, Zile State Hospital, Tokat, Turkey
| Date of Web Publication | 15-Jul-2014 |
Correspondence Address:
Erhan Ayhan
Department of Dermatology, Zile State Hospital, Tokat
Turkey
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-7753.136753
 Abstract | | |
Pilomatrixoma is a benign soft tissue neoplasm originated from follicular matrix of hair and is also known as Malherbe's calcified epithelioma. Some lesions are located on the skin and are usually misdiagnosed. A small number of patients had been dermoscopically examined. In this article, three patients of pilomatrixoma who had three different dermoscopic views were evaluated and discussed in concordance with the literature. Keywords: Dermoscopy, nonvascular structures, pilomatrixoma, vascular structures
How to cite this article:
Ayhan E, Ertugay O C, Gundogdu R. Three different dermoscopic view of three new cases with pilomatrixoma
. Int J Trichol 2014;6:21-2 |
| Introduction | |  |
Pilomatrixoma is a benign adnexal dermal or subcutaneous tumor [1] derived from immature matrix cells. It is first described by Malherbe and Chenantais in 1880 as a calcified tumor originating from sebaceous glands and named as pilomatrixoma by Forbis and Helwig in 1961. [1] A female predominance is known. In terms of clinical manifestation it is a single, solid, deep subcutaneous or dermal mass. It is usually localized in the head and neck region and also on upper extremities. As it has a wide variety of clinical findings, it is usually misdiagnosed. Lesions located on the skin are usually bluish or reddish in color and could morphologically vary in bullous, anetodermic or perforated masses. [2] Recently, there has been only one dermoscopic study, which had focused on diagnosis of over skin located lesions. In this article, three cases of pilomatrixoma were discussed histopathologically by using dermoscopic evaluation.
| Case reports | | |
Case 1
A 67-year-old female patient has been complaining of a painless, reddish mass on her right cheek. On dermatological examination, a nodular, well-marginated, and reddish lesion of 2 cm × 2.5 cm in diameter was identified. Round yellowish spots were also seen. Dermoscopic evaluation demonstrated yellowish lobules on an erythematous background, surrounded by crown-like branching vessels [Figure 1]a]. A diagnosis of pilomatrixoma was made. | Figure 1: (a) Dermatoscopy showing yellowish lobules surrounded by crown like vessels (gross tumor is seen in the right-upper corner of image, ×10). (b) Bluish-white fishing net-like streaks is seen the entire image (inset of gross tumor in the right-upper corner of image, ×10). (c) In the dermoscopic view, there are polymorphous vessels (predominated linear irregular vessels), bluish areas (left-middle side of image) and ulcerations (inset of gross tumor in the right-upper corner of image, ×10)
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Case 2
A 48-year-old male patient had a reddish nodule on his left eyebrow which had been growing slowly by 2 months. Reddish, 1 cm × 1 cm sized nodule with hairy surface was detected on the medial side of left eyebrow. Dermoscopic examination revealed erythema and bluish-white streaks like a fishing net [Figure 1]b]. These findings were in concordance with pilomatrixoma.
Case 3
A 58-year-old male patient admitted with a reddish nodule on upper left side of the nose. Physical examination revealed a reddish nodule on upper left side of nasal dorsum with an ulcerated area on its surface. Dermoscopic examination demonstrated erythema, linear irregular vessels, hairpin like vessels, comma like vessels, ulceration, and bluish areas [Figure 1]c]. A diagnosis of pilomatrixoma was made.
| Discussion | | |
Dermoscopy is a diagnostic procedure focusing on evaluation of epidermal and superficial dermal structures. Although it is widely used in diagnosis of melanocytic lesions, nonmelanocytic structures have also been observed recently. First dermoscopic findings of pilomatrixoma were defined by Zaballos et al. they had reported dermoscopic results of 10 cases of pilomatrixoma in this article. Nonvascular, irregular, whitish formations (80%) and streaks (70%) were commonly observed. They assessed these findings equivalent to presence of calcification and cornified material. Reddish homogenous zones (90%), hairpin like vessels (70%), linear irregular vessels (70%) and dotted vessels (70%) were identified as vascular structures. [3] Zalaudek et al.[4] and Rosendahl et al. [5] reported two studies which comprised of keratoacanthoma and squamous cell carcinoma patients and emphasized whitish unstructured zones on dermoscopy. In addition, white rings, targetoid hair follicles, central keratin accumulations and hairpin vessels are more likely to be seen in squamous cell carcinoma and keratoacanthoma. [4],[5] White zones are also reported in Merkel cell carcinoma cases. White zones together with streaks were mentioned in two previously published articles. [6],[7] Milky pink zones, linear irregular vessels and branching vessels were also demonstrated in Merkel cell carcinoma. [6],[7] In case 1, yellowish-white zones were surrounded by crown like shaped branching vessels. These findings are also common in sebaceous hyperplasia, [8] and molluscum contagiosum. [9] Case 2 demonstrated fishing-net like bluish-white streaks. Although streaks hadn't been reported in cases out of pilomatrixoma, they could be seen in figures of some articles about Merkel cell carcinoma. [6],[7]
Linear irregular vessel and hairpin like vessel were detected in case 3. Linear irregular vessels are also commonly observed in Merkel cell carcinoma [6],[7] and melanoma. [10] Two articles about Merkel cell carcinoma which comprised of 10 and two cases also demonstrated these linear irregular vessels in all subjects. [6],[7] Hairpin like vessels on the other hand, are commonly seen in nonmelanocytic lesions such as seborrheic keratosis, keratoacanthoma and squamous cell carcinoma. [10]
| Conclusion | | |
Yellowish-white structures together with streaks, linear irregular vessels and hairpin like vessels are supportive dermoscopic findings of pilomatrixoma those are located on the skin however this is not enough for definitive diagnosis.
| References | | |
| 1. | Forbis R Jr, Helwig EB. Pilomatrixoma (calcifying epithelioma). Arch Dermatol 1961;83:606-18. 
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| 2. | Pirouzmanesh A, Reinisch JF, Gonzalez-Gomez I, Smith EM, Meara JG. Pilomatrixoma: A review of 346 cases. Plast Reconstr Surg 2003;112:1784-9.
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| 3. | Zaballos P, Llambrich A, Puig S, Malvehy J. Dermoscopic findings of pilomatricomas. Dermatology 2008;217:225-30.
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| 4. | Zalaudek I, Giacomel J, Schmid K, Bondino S, Rosendahl C, Cavicchini S, et al. Dermatoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: A progression model. J Am Acad Dermatol 2012;66:589-97.
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| 5. | Rosendahl C, Cameron A, Argenziano G, Zalaudek I, Tschandl P, Kittler H. Dermoscopy of squamous cell carcinoma and keratoacanthoma. Arch Dermatol 2012;148:1386-92.
[PUBMED] |
| 6. | Ciudad C, Avilés JA, Alfageme F, Lecona M, Suárez R, Lázaro P. Spontaneous regression in merkel cell carcinoma: Report of two cases with a description of dermoscopic features and review of the literature. Dermatol Surg 2010;36:687-93.
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| 7. | Harting MS, Ludgate MW, Fullen DR, Johnson TM, Bichakjian CK. Dermatoscopic vascular patterns in cutaneous Merkel cell carcinoma. J Am Acad Dermatol 2012;66:923-7.
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| 8. | Zaballos P, Ara M, Puig S, Malvehy J. Dermoscopy of sebaceous hyperplasia. Arch Dermatol 2005;141:808.
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| 9. | Ianhez M, Cestari Sda C, Enokihara MY, Seize MB. Dermoscopic patterns of molluscum contagiosum: A study of 211 lesions confirmed by histopathology. An Bras Dermatol 2011;86:74-9.
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| 10. | Argenziano G, Zalaudek I, Corona R, Sera F, Cicale L, Petrillo G, et al. Vascular structures in skin tumors: A dermoscopy study. Arch Dermatol 2004;140:1485-9.
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