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Medical Professionals Reference (MPR)Clinical Challenge: Flesh-Colored Nodule on Cheek

A 64-year-old woman presents with a lesion on her right cheek, first noticed 18 months ago. Initially, the lesion was treated with triamcinolone injections. Over the past three months, she observed a significant increase in size and a whitish discharge upon manipulation. The physical examination revealed a 1.8 cm firm, flesh-colored nodule with two whitish papules within the medial border.

Diagnosis Options:

  • Pilomatrixoma: A benign tumor originating from the hair follicle matrix, characterized by mutations in the WNT-signaling pathway. It typically presents as a firm, flesh-colored nodule and can be associated with several genetic syndromes.
  • Epidermoid Cyst: A common cutaneous cyst that may arise from the epidermis, often presenting as a nodular lesion and can discharge keratinous material when ruptured.
  • Chondromyxoid Fibroma: A rare benign bone tumor that usually presents in the metaphysis of long bones but can occasionally appear in soft tissue, displaying a firm, nodular growth.
  • Fibroxanthoma: A benign fibrous histiocytoma that can occur in soft tissue, presenting as a nodular growth, often without specific distinguishing clinical features.

Question: Based on the patient’s presentation and lesion characteristics, which condition would you diagnose?

Pilomatrixomas have a bimodal distribution of occurrence, with a peak incidence between birth to under 30 years and a second peak incidence between 50 and 65 years

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