[Proliferating pilomatricoma treated using a bilateral advancement flap].

730 To the Editor: Pilomatricoma is a benign neoplasm that is generally straightforward to diagnose clinically. It initially takes the form of a small tumor of nonspecific appearance but displays a characteristic firm consistency to palpation as it develops. We present the case of a giant pilomatricoma on the scalp, noting the abnormal morphology and rapid growth. We also describe a surgical solution in the form of a bilateral advancement flap or H-plasty. The clinical and pathological characteristics suggest that our case could be proliferating pilomatricoma. Pilomatricoma or calcifying epithelioma of Malherbe was first reported in 1880, when Malherbe and Chenantais described a tumor they initially denominated " calcified epithelioma of the sebaceous gland. " Just a year later, Malherbe published 18 cases stressing the fact that this tumor tended to affect young people. More than 50 years later, in 1933, Chin Luang-Yu identified calcification as another common characteristic of pilomatricoma, and this tumor became known as " calcifying epithelioma of the skin. " In 1942, Turhan and Kranier identified the site of tumor origin as the hair follicle and shortly afterwards, in 1949, Lever and Griesermer pinpointed it to the primary epithelial germ cells. The current name of pilomatricoma was proposed in 1961 by Forbis and Helwig after they presented a series of 240 examples of the tumor. Subsequent authors contributed further information on the neoplasm: an association with myotonic dystrophy was described by Cantwell and Reed in 1965, and a link with diabetes by Harper in 1971. We present the case of a 41-year-old man with no relevant medical history, who attended for the appearance of a tumor in the frontoparietal region. Rapid tumor or growth had prompted the patient to make a hasty appointment as the tumor reached the size seen in the photograph (Figure 1) within 4 to 6 weeks. The size of the lesion caused some discomfort and a continual sensation of tension in the area around the tumor that occasionally led to localized pain or a more widespread headache (possibly of a tension type). Examination revealed a multilobulated tumor measuring 4.2 cm in diameter. It was of an erythematous violaceous color and had a hard consistency without becoming stony (falling short of the expected hardness for classic pilomatricoma). Given the clinical appearance and rapid growth of the tumor, dermatofibrosarcoma, melanoma, and cutaneous metastasis were ruled out. Histology was conclusive and revealed tumor proliferation compatible …