Clinical and pathological features of 209 cases of pilomatricoma in children: a retrospective study

Our findings demonstrate distinct gender-based anatomical distribution patterns and excellent surgical outcomes for pediatric pilomatricoma. The integration of high-frequency ultrasonography with clinical evaluation significantly enhances diagnostic accuracy, potentially reducing unnecessary interventions in this population. These findings provide critical references for clinicians regarding disease characteristics and diagnostic optimization. Key messages What is already known: Pilomatricoma is a benign hair matrix-derived tumor with diverse clinical presentations, often leading to misdiagnosis. Previous studies have reported its association with Wnt/β-catenin pathway mutations and a predilection for the head/neck region in children, but comprehensive analyses of gender-specific anatomical distribution and diagnostic optimization are lacking. What this study adds: This large pediatric cohort reveals gender differences in anatomical involvement (female predominance in limb/trunk lesions) and demonstrates that high-frequency ultrasonography (88.2% calcification detection) significantly improves preoperative diagnostic accuracy (71.3% vs. historical rates of 16%-43%). How this study might affect research, practice, or policy: The findings advocate for integrating ultrasonography into clinical workflows to reduce misdiagnosis and unnecessary interventions. Gender-specific patterns may prompt research into hormonal influences on tumor pathogenesis. Surgical excision remains definitive, with no recurrence, reinforcing its role as first-line therapy.