Madahar G, O’Connor J, Pappa E and Pollock J
Pilomatrix Carcinoma (PC) is seldom reported in the literature. These cancerous lesions present secondary to malignancy of the hair matrix. The consensus is that these malignancies tend to demonstrate an aggressive infiltrative pattern even in the face of local excision, with a subsequently elevated propensity for recurrence. Lymph node involvement and distant metastases are periodically witnessed. The primary treatment modality should comprise of surgery with adjuvant radiotherapy were deemed prudent. Regular follow up appointments are judicious since systemic metastases and nodal involvement can, unfortunately, unveil following the initial diagnosis and treatment plan. The case presented here illuminates an unusual encounter of a large cutaneous forehead pilomatrix carcinoma invading the frontal sinus, eroding the skull, and infiltrating the intradural/intracerebral compartment of the brain. This tumor was treated with wide local excision of the cutaneous tumor invading the surrounding skull, nasal bone with intradural/intracerebral components, en block excision of the bifrontal abscesses, and reconstruction with a scalp rotational flap and a split skin thickness graft harvested from the thigh for the cutaneous defect. The patient also had adjuvant radiotherapy as there was histological evidence of microscopic tumor cells at the margins of the resection. The patient has been followed up for 3 years and there were no signs of local or regional recurrence.