Pediatric cervical pilomatrixoma: clinical and ultrasound approach to an unexpected mass

Dermal lesions in the pediatric population are a frequent reason for consultation that requires a systematic evaluation due to their broad differential diagnosis, including infectious processes, malformations, and tumors.

We present the case of a boy aged 9 years with a left-sided cervical lesion of three month’s duration. The mass was hard, bluish in color, and showed progressive growth despite topical antibiotic therapy. A bedside ultrasound examination revealed hyperechoic areas suggestive of calcifications, leading to an initial diagnosis of pilomatrixoma. This was supported by a formal ultrasound and confirmed by the histological analysis of the surgical specimen after removal of the lesion.

Pilomatrixoma should be considered in the differential diagnosis of pediatric cervical masses. The clinical ultrasound is a key tool to guide the diagnosis in order to optimize referrals and avoid unnecessary tests or interventions.