LAUSR

Pilomatrical carcinoma is one of the rare adnexal tumors with only 140 reported cases according to recent literature. The tumor has a propensity to arise in posterior neck, upper back and lower extremities and has 100% mortality if metastasizes. Hence, it is imperative to document the illusive nature of this deceptive tumor. The case under discussion is that of a 70-year-old male presenting with multiple small to large non-tender firm lesions over the scalp. The tumor, labeled as proliferative trichilemmal cyst, radiologically was excised, and the scalp was reconstructed by mobilization of the local area. Extensive sampling of the specimen received revealed morphology of pilomatricoma and trichilemmal cysts with a focus of stromal invasion in one of the lobules of pilomatricoma. Hence, a diagnosis of pilomatrical carcinoma was made, and the patient is on close follow-up since 1 year post-operatively with no signs of recurrence or cervical lymphadenopathy. Though of low malignant potential, the tumor is said to have recurrence potential. The prognosis is variable depending on the evidence of metastasis found if, at all, the mortality is 100%. Hence, extensive sampling and accurate diagnosis are essential to rule out the possibility of malignancy.