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The pilomatrixoma is a benign skjn lesion bearing i.nitially resemblance to an inclusion cyst. Later the tumor enlarges and may assume the form of a large cyst 2 or an ulcerated tumor resembling basoquamous cell carcinoma. (Figure I and Figure. 20). Pilomatrixoma (calcifying epithelioma of Malherbe) was described initially by Malherbe and Chenatasis' in I H80. Its similarity to the more common cysts and its confusing cell origin have contributed to its clinical obscurity. Forbis and HelwigJ suggested in 1961. renaming t his lesion as pilomat rixoma (stemming from primitive hair matrix cells). Incidence: Several authors 4.5 report the incidence as one in 2000 surgical specimens, whereas6 another study reports an incidence of one per 824 specimens. The tumor is seen in all age groups, but 40%are seen before age 10 and 60% before age 20. A ferna Ie to male ratio of 3:2 is reported, with the white nice primarily affected. Differential diagnosis often includes sebaceous cysts. giant celJ tumor, ossifying hematoma. metastatic calcification, chondroma. dermoid cysts, foreign bod reaction and degenerating libroxanthoma. The tumor almost always occurs singly. The arms (35%). the face (21 %), the neck (J 3%), and the thighs (10%) were the most common sites in the patients studied by Forbis and Helwig. Radiologit Appearance: Because the tumor is generally small and innocuous, radiologic examination is rarely performed. however, the radiographic appearance of heavily calcified tumors is distinctive. The tumors have a regular contour and are sharply demarcated from the surrounding fat. The overlying skin may be normal but usually is thin. Calcification1 may not be visible with conventional soft tissue technique, and low-kilovoltage radiography with nonscreen or industrial film is preferable. Most reported cases have homogeneous speckles or sandlike calcification. However. large dense foci of calcification have been described . The radiographic finding of a solitary. sharply demarcated subcutaneous tumor with extensive sandlike dense focal calcification is probably palhognomonic of pilomatrixoma. However, the differential diagnosis mentioned above should be kept

Pilomatrixoma (Calcifying Epithelioma of Malherbe)