Surgical Management of Pediatric Pilomatricomas: Recurrence Risk and Minimally Invasive Approaches

Pilomatricoma is a benign skin tumor arising from follicular matrix cells that most commonly affects children. A pilomatricoma is a firm, often calcified dermal nodules can be managed with traditional wide excision, but rising interest in cosmetically favorable, less invasive techniques has influenced pediatric surgical practice. However, every surgical option carries some risk of recurrence, largely linked to incomplete removal. This review examines nine key pediatric studies, representing diverse surgical modalities, to evaluate recurrence rates, procedural outcomes, complications, and cosmetic considerations. A structured search was conducted to systematically identify these studies, which were then analyzed for study characteristics and outcomes. Results suggest that complete excision remains the most reliable method to minimize recurrence, which typically occurs in under 5 percent of cases when margins are clear, whereas minimally invasive approaches can achieve favorable aesthetic results in selected superficial and well‑circumscribed lesions, provided intraoperative visualization is adequate. Complication rates across all techniques are low, and functional outcomes reflect high safety profiles. Nevertheless, clear documentation of margin status, standardized follow‑up, and patient‑reported cosmetic satisfaction remain inconsistent. A decision algorithm is presented to guide procedural choice based on lesion characteristics and cosmetic priorities. Continued improvement in data reporting, including recurrence metrics and cosmetic scoring, is required to refine pediatric pilomatricoma surgical guidelines.