Emerging Role of Hepatic Ketogenesis in Fatty Liver Disease.

BACKGROUND Pilomatrixomas are benign skin tumors that tend to occur in children. They most commonly arise in the head and neck region, but their appearance in the ear, especially the earlobe, is rare. Clinically, these lesions present as firm, non-tender nodules, occasionally with a reddish or bluish tint. Given the lesions' typical features, experienced clinicians may opt for surgical excision without extensive workup. Still, diagnosis can be challenging when the lesion is located in an unusual site, like the auricle, where it can resemble other skin conditions. In this report, we describe a case of earlobe pilomatrixoma and outline its clinical presentation, surgical management, and histopathological findings. CASE REPORT A 6-year-old girl presented with a painless, stable mass on her right earlobe, first noticed at the age of 3 years. Physical examination revealed a firm, non-tender, well-circumscribed, mobile lesion, with no overlying skin changes or history of trauma. No previous imaging or investigations were conducted. After discussion, surgical excision was performed. Histopathological analysis showed alternating eosinophilic and basophilic calcified areas, abundant anucleate eosinophilic ghost cells, and multinucleated giant cells, confirming pilomatrixoma. Notably, basaloid and transitional cells were absent, suggesting lesion maturity. CONCLUSIONS This case emphasizes the importance of considering pilomatrixoma in the differential diagnosis of pediatric head and neck masses and how it might even present in some unusual locations, such as the auricle. Recognizing its clinical features can facilitate effective management while minimizing unnecessary diagnostic tests. In this case, we highlighted an efficient approach and raised awareness of pilomatrixoma's distinctive presentation.