Pilomatrixoma with Dr. Rebeccah Brown

As we know, the differential diagnosis for soft tissue masses in children is broad. And so today, Dr. Rebecca Brown is going to share her diagnostic tips and tricks in our lump and bump Stay Current Short. Let's get started with our first case. So this is a 5-year-old girl, she's comes to your office, um she's got this this was actually a patient that I I saw not too long ago, has a discolored hard mass just behind the left ear. It's not painful, it seems to be increasing in size a bit. The discoloration here may lead us to think vascular malformation, but the physical exam findings don't quite fit. It's not softer, squishy, or anything like that, it's really really firm and hard, it actually feels like a a big old bunch of pebbles kind of sitting under the skin. Right, so not quite the profile of vascular malformation. And it's mobile. You can move it around, you can move it around. It doesn't hurt her, it doesn't seem attached to anything. This is a pilomatricoma. And sure, here we see it behind the ear, which is the most common location, but we can find them all over the body, on the arms or legs, or even on the trunk. Yes, this is a pilomatricoma, pretty classic. They always look kind of discolored, they're kind of raised, they got this they're really hard and you can kind of move them around. Uh so here's what it kind of looks like when you um size it, it's got bunch of this kind of it's calcified stuff in the middle is really chalky. This is a benign tumor of the hair matrix where it creates a calcified epithelioma with an angulated or regular shape. The physical exam finding is called the tent sign. If they have multiple of these, it can be associated with myotonic dystrophy and Rubinstein-Taybi syndrome, which is one of my least favorite syndromes ever. In older people, pilomatrix carcinoma has been reported, but it's really rare. Anyways, the recommendation is still for surgical excision of these lesions. Thanks for joining our Stay Current Short on pilomatricoma. Be sure to check back for the next episode by checking out our YouTube channel, our social media, and of course by downloading the Stay Current app. Until next time, I'm Brittany with Stay Current, and remember, knowledge should be free.