Martin S, DeJesus J, Jacob A, Qvavadze T, Guerrieri C, Hudacko R, Boucree T. Pilomatrix carcinoma of the right postauricular region: A case report and literature review.
Int J Surg Case Rep 2019;
65:284-287. [PMID:
31756690 PMCID:
PMC6872857 DOI:
10.1016/j.ijscr.2019.10.087]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/31/2019] [Indexed: 12/04/2022] Open
Abstract
Pilomatrix carcinoma is a very rare locally aggressive tumor.
A well-defined gold standard for surgical management has not been established.
Currently wide local excision with safe margins is recommended.
Regional lymph node dissection is performed when metastasis is suspected.
Introduction
Pilomatrix carcinoma is a rare aggressive tumor with a high rate of local recurrence after surgical excision. Diagnosis is made by histopathology and when discovered, wide local excision has been shown to have the best results.
Presentation of case
We report a case of a 74-year-old male incidentally found to have a large right postauricular mass and regional lymphadenopathy. The mass was biopsied and proven to be a malignant pilomatrixoma. Wide local excision and level II and III neck dissection with reconstruction using a right supraclavicular flap was performed.
Discussion
Pilomatrix carcinoma is a lesion first described in 1880 by Malherbe and Chenantais. It is unknown if these tumors arise de novo or arise through malignant transformation of a benign pilomatrixoma. There are similarities between the benign lesion and its malignant counterpart in terms of activating mutations in signaling pathways. A well-defined gold standard for surgical management has not been established, but currently wide local excision with safe margins is recommended along with regional lymph node dissection when metastasis is suspected. Currently, no chemotherapy regimen has been shown to be effective in local control or in preventing metastatic spread.
Conclusion
Pilomatrix carcinoma, given its aggressive nature, has a high propensity for recurrence after excision. It is important to perform wide local excision to avoid an incomplete resection and higher recurrence rates. Further studies will be needed to create a more defined standard of treatment and to evaluate the role of adjuvant chemotherapy and radiation therapy.
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