Dear Dawnie,
This most likely is A pilomatrixoma. Also with the white center another possible cause is epidermal inclusion cyst. Both are usually benign. Sometimes have to be removed by dermatologist.
A Pilomatrixoma is a benign appendageal tumor with differentiation toward hair cells. It usually manifests as a solitary, asymptomatic, firm nodule. It has long been considered a rare tumor, but it may be more common than previously realized. It is more common in children, but occurrence in adults is increasingly being recognized. Recommended treatment is surgical excision. Multiple pilomatrixomas have been observed in association with myotonic dystrophy. Pilomatrix carcinoma is a rare condition.
- Patients usually present with a solitary nodule that has been slowly growing over several months or years.
- Patients are usually asymptomatic, but some report pain during episodes of inflammation or ulceration.
- Rapid growth is rare, but reports indicate one lesion reaching 35 mm in 8 months and another reaching 1 cm in 2 weeks.
- Occurrence in more than one member of the same family is rare and is usually observed in association with myotonic dystrophy.
Physical:
- Approximately 50% of the lesions occur on the head and neck, especially the cheek, preauricular area, eyelids, forehead, scalp, and lateral and posterior neck.
- Lesions can also occur on the upper and lower extremities and trunk.
- One lesion was observed in the middle ear and another in the ovary.
- Most lesions measure 0.5-3 cm, but, rarely, giant lesions up to 15 cm are reported.
- Patients usually have a single, firm, stony, hard nodule.
- Lesions are usually the color of the normal skin, but reddish-purple lesions have been observed (probably resulting from hemorrhage).
- Stretching of the overlying skin can give the lesion a multifaceted, angulated appearance known as the “tent sign," likely due to calcification in the lesion.
- One lesion showed the "dimple sign," which is often associated with dermatofibromas.
- Unusual morphological variants include a keratoacanthomalike appearance, perforating lesions, cystic lesions, bullous appearance, and lesions that show anetodermalike changes on the surface.
Causes: Investigators in one study showed that at least 75% of the lesions studied had mutations in the gene CTNNB1; these data directly implicate beta-catenin/LEF misregulation as the major cause of hair matrix cell tumorigenesis in humans.
Emedicine.com.
I hope this helps. I know it is technical. Good luck.Images available only to Customers.
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