Surgical treatment of pilomatrix carcinoma: a systematic review

Pilomatrix carcinoma (PMC), also known as pilomatrical carcinoma, is a rare, malignant tumor of the hair follicle that may arise from a benign pilomatricoma or de novo and carries a high risk of recurrence and metastasis. This study sought to investigate and compare surgical modalities for PMC, including reported outcomes and recurrence rates. In July 2024, a systematic review of PubMed, Embase, and Web of Science databases on surgical modalities and PMC was conducted. Randomized controlled trials and observational studies were included. The search yielded 257 articles; after the application of inclusion and exclusion criteria, 50 articles were included: four case series and 46 case reports with a total of 101 cases. There were 17 cases treated with Mohs micrographic surgery (MMS) with no recurrences. There were 84 cases treated with surgical excision with an overall recurrence rate of 34.5%. The mean follow-up time was 7.5 months for MMS and 7.6 months for surgical excision. MMS showed excellent outcomes for PMC with no recurrences compared with a recurrence rate of 34.5% for surgical excision (P < 0.0025). No recurrences or metastases were found on follow-up reported in all 17 cases treated with MMS in the literature, compared with a recurrence rate of 34.5% for the 84 cases of surgical excision. Due to the importance of early surgical intervention and attaining true negative margins to prevent recurrence and metastasis, MMS should be considered for the treatment of PMC, especially where tissue sparing is essential.