Calcifying epithelioma on the face of a middle-aged man.

A 42-year-old man presented with a nodule on the left cheek that had gradually increased in size. Physical examination revealed a yellowish subcutaneous tumor. The biopsy specimen revealed epithelial sheets consisting of anucleate squamous cells, basophilic cells, and foreign body giant cells. These findings confirmed that this tumor was a calcifying epithelioma.

A 42‐year‐old man presented with a nodule on the left cheek that had gradually increased in size over the past 10 years. Physical examination revealed a circumscribed, hard, freely movable, yellowish subcutaneous tumor, measuring 1 cm in diameter (Figure 1). No pain or foul odor had been associated with the tumor during the 10 years. An excisional biopsy was performed for diagnosis and treatment. The biopsy specimen revealed epithelial sheets consisting of anucleate squamous cells, basophilic cells, and foreign body giant cells (Figure 2). These findings, and the clinical course, confirmed that this tumor was a calcifying epithelioma. There has been no recurrence of the tumor as of the sixth month of follow‐up. A calcifying epithelioma (pilomatricoma) occurs more frequently in children than in adults. The frequency is as high as 60% among those aged 30 and younger. However, a second smaller peak of onset of 28% has been reported in the elderly between the ages of 50 and 70 years.1 Calcifying epithelioma is typically a benign skin tumor derived from the hair matrix2 and occurs in the head and neck in 40%–77% of cases.1 Although this tumor is well recognized by dermatologists and pathologists, the accuracy rate of the preoperative diagnosis of calcifying epithelioma ranges from 0% to 30%2 due to the variety of potential conditions included in the differential diagnoses, indicating that most clinicians are not familiar with this tumor. Complete surgical excision of a calcifying epithelioma may be considered if cosmetically acceptable. The conventional choice is fusiform excision for en bloc removal of a tumor over 2 cm in diameter. This can possibly cause a major cosmetically unacceptable skin defect and excessive bleeding if performed by an inexperienced family physician. By contrast, a simple excisional biopsy of a tumor that is less than 1 cm is a useful, safe, and acceptable approach for any physician. Delayed diagnosis of a tumor that grows to more than 2 cm in size on the face may result in a cosmetic defect. In this case, an excisional biopsy was the preferable. A calcifying epithelioma grows slowly over a period of several months or years. In general, the appropriate recommendation is to monitor the tumor for any changes, especially exulceration and rapid growth. In cases of repeated local recurrence after surgery, malignant transformation of the calcifying epithelioma rarely occurs, except in middle‐aged or elderly patients. If we identify a subcutaneous tumor less than 1 cm as a calcifying epithelioma in middle‐aged or elderly patients, excisional biopsy may be recommended.

Figure 1

Physical examination showing a yellowish subcutaneous tumor

Figure 2

The biopsy specimen revealing epithelial sheets

CONFLICT OF INTEREST

The authors have stated explicitly that there are no conflicts of interest in connection with this article.