Dermatology: Practical and Conceptual


36 Letter  |  Dermatol Pract Concept 2019;9(1):9

Dermatology Practical & Conceptual

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 epi-

thelioma 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, degenerat-

ing 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 pre-

auricular, firm, solitary lesion that had been growing slowly 

for the 2 months before the first visit (Figure 1). Dermoscopy 

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

Jelena Krtanjek1, Ivana Ilic2, Mateja Kendel3, Ruzica Jurakic Toncic4

1 Division of Dermatology and Venereology, General Hospital Varazdin, Varazdin, Croatia

2 Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia

3 Division of Dermatology and Venereology, County Hospital Cakovec, Cakovec, Croatia

4 University Department of Dermatology and Venereology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, 

Zagreb, Croatia

Key words: pilomatricoma, epidermal cyst, dermoscopy

Citation: Krtanjek J, Ilic I, Kendel M, Jurakic Toncic R. Epidermal cyst on the face of a child, clinically and dermoscopically mimicking 
pilomatricoma. Dermatol Pract Concept. 2019;9(1):36-37. DOI: https://doi.org/10.5826/dpc.0901a09

Published: January 31, 2019

Copyright: ©2019 Krtanjek et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Ruzica Jurakic Toncic, MD, University Department of Dermatology and Venereology, University Hospital Centre 
Zagreb, University of Zagreb, School of Medicine, Salata 4 10000 Zagreb, Croatia. Email: rjtoncic@gmail.com

Figure 1. Clinical presentation of a preauricular, firm, solitary lesion 

on the face of a 6-year-old girl. [Copyright: ©2019 Krtanjek et al.]



Letter  |  Dermatol Pract Concept 2019;9(1):9 37

its frequent incidence, this diagnosis should be considered 

when evaluating similar skin lesions, to avoid unnecessary 

surgical excision.

References

1. Ghigliotti G, Cinotti E, Parodi A. Usefulness of dermoscopy for the 

diagnosis of epidermal cyst: the ‘pore’ sign. Clin Exp Dermatol. 

2014;39(5):649-650. 

2. Fernández Atuan R, Álvarez García N, González Ruiz Y, Siles 

Hinojosa A, Rihuete Heras MA, Elías Pollina J. The diagnosis of 

pilomatrixoma in children is not as easy as it may seem: a review 

of 126 cases [in Spanish]. Cir Pediatr. 2017;30(1):46–49.

revealed erythematous border, irregular white structures, and 

brown-blue central pigmentation (Figure 2).

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. Histopa-

thology 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).

Conclusions

We believe that this is the first report of an epidermal cyst 

on the face of a child with these dermoscopic features. Given 

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.]

Figure 3. A cyst lined by an epidermis-like epithelium including a 

granular cell layer, filled with laminated keratin. [Copyright: ©2019 

Krtanjek et al.]