Four patients who presented with an upper lid mass were diagnosed with pilomatricoma after excisional biopsy. We report the cases to improve the differential diagnoses of upper lid masses through investigation of the clinical manifestations and radiological findings of pilomatricoma.

Three females and one male with ages of six, seven, eight and 46 years, respectively, each presented with a slowly growing and painless upper lid mass of a three-month duration. In the six-year-old patient who had a history of trauma related to the mass, the mass was fixed to the skin, although the masses were movable in the other patients. Upon computed tomography (CT), well-circumscribed, enhancing nodules were found. Excisional biopsy was performed for definite diagnosis and treatment. All completely excised masses were hard and encapsulated with a thin membrane. The sizes of the masses were 12 mm, 10 mm, 10 mm, and 7 mm. Histopathologic examination with hematoxylin-eosin staining confirmed the masses to be pilomatricoma. There was no evidence of recurrence at 16, 2, 19, and 21 months after mass excision.

In patients presenting with a painless upper lid mass, pilomatricoma should be considered in the differential diagnosis.