Four months post surgery

Her scar looks quite good, can't say enough about the plastic surgeon at U-M who did the work:

Removal Surgury Done!

We are on the good side of this ordeal!  Our daughter had her removal surgery three weeks ago.  This picture was taken one day after surgery, when the tape was still covering the incision.  She did great, the procedure was done by a pediatric plastic surgeon (Dr. Steve Kasten at U-M Mott--Loved him!)  Dr. Kasten did a GREAT job on the scar, now that the tape is removed the area is still red (and may remain that red for up to a year after the trauma from the infection swelling) but the scar itself is less than a centimeter and almost invisible to the naked eye.  AMAZING!  My visions of a Frankenstein-style scar on her face were completely off.  Three weeks post-operation, her face looks great and after they removed the stitches (a painless tug on a nylon thread) we were released from even having to go back to check on the incision.  The biopsy of the mass actually showed neither pilomatricoma NOR a cyst--just a dermal fibriosis, or a bit of tissue living somewhere it shouldn't under the skin and causing problems.  Strange.  So, life goes on, and hopefully THIS is the worst thing that ever happens to our child--we'd be so lucky!

Removal surgery scheduled...

We had our long awaited appointment with U-M Pediatric Plastic surgeon Dr. Steven Kasten today...a great guy, seemed very capable and engaged.  We found out she will have the removal surgery in one month, as we wait for the tissue surrounding the mass to return to normal.  The procedure will be outpatient, requiring general anesthesia and a small half-inch incision. 

Her spot looks great, flaky skin around the mass from where it was stretched to the breaking point and one small scab where it broke open on Sunday.  Dr. Kasten will take care of any scarring from the break during surgery, so she should just have a simple straightline incision scar, which should fade over time.  Ready to be done with all this!

Pilomatricoma requires hospital stay

We spend Memorial Day weekend in our least favorite place--U-M Mott Children's Hospital.  As the dermatologist predicted my daughter's pilomatricoma (or sebaceous cyst, we're not sure which) flared up about two weeks ago.  It gradually got redder and larger, until I was certain this wasn't "normal" flare up anymore and warranted a trip back to the dermatologist Friday morning.   

He sent us immediately to the pediatric ER, where the doctors diagnosed cellulitis around the cyst threatening her eye and eye sight.  She got on an antibiotic IV and remained such for three days.  

(picture: The cyst or pilomatricoma at its worst in the hospital, two weeks after it began to be inflamed)

She had an ultrasound Friday in the ER to determine if the bump was fluid or solid.  The U/S showed it was a fluid-filled abscess, but that could have formed in front of the pilomatricoma or it may be that she has a cyst (fluid-filled benign structure) not a pilomatricoma (solid-filled benign structure), but the difference is more academic than practical.  They were contemplating surgery to drain it but fortunatly it responded to antibiotics (IV clindamyacin) in time.  Other than a lot of waiting around, doctors poking at her face and one really bad hour on Friday getting her IV inserted, she had a good time at Mott--they have a play room with toys and activities and an outdoor playground, and she watched ALOT of Dora and Diego, which she loved.  So all in all not too much trauma--just on us, who can't believe we have now had two separate hospital stays with both our little girls. 

We feel pretty unlucky and hope soon we'll be done with hospital stays for a very long time.  As always, three days at a children's hospital can do nothing but make you thankful you are not a family stuck there chronically with a desperately ill or damaged child---the snippets you overhear are heartbreaking.  We met a two year old boy waiting for a heart and our roommate, a 16 month old with unrelenting knee infection threatening leg amputation.  You see teens laying silently in beds, their limbs twisted and contorted in ways that suggest a lifelong battle with a birth defects, or kids with bandages wrapped around their heads, victims of accidents or bad luck or I dont' even want to guess.  One little boy (12ish) was playing video games in teh play room until a nurse told him his dialysis was ready.  Seeing the possibilities up close alters who you are as a parent, just for knowing how close any of us are to that life.  No one asks for it, but so many families soldier on because, really, what choice do you have?

So thankfully, even a horribly infected pilomatricoma, or sebaceous cyst, can be treated with modern medicine (she's now on augmentin for 14 days orally) and remain relatively benign.  We have a follow up with the plastic surgeon on Thursday (ironically, the exact same appointment I've had for a month, which was supposed to be our removal consultation).  We should find out more about the removal surgery, which they will do in about a month when the tissues surrounding the structure are completely calm and uninflamed.

"I want this thing off my face!"

This is the sad thing my three year old, who has been diagnosed with a 4mm by 6mm pilomatricoma on her right cheek, says to me last night as we are lying in her bed.  And I agree.  But before we get there, we should summarize the last nine months of this "thing's" presence on her face:  It wasn't there, and then it was, and then it stayed. 

I first noticed what looked like a plugged pore around October, and resisted the urge to pick at it.  it was small, like a blackhead but slightly off center to what looked like a small smooth bump underneath it.  Weird.  In February, it flared up, pussed and red and looking like a zit ready to explode.  That should be the end of that, I figured.  Blackhead becomes zit, then goes away.  But it didn't--it returned to about the same state as before, and I was ready to figure out what the heck this thing was.

(picture: very benign looking opening to a cyst or pilomatricoma in February)

Our pediatrician guessed it was a sebaceous cyst, harmless but removable by a dermatologist if we didn't want to wait for it to dissipate on its own.  I waited a few more months to make the dermatologist appointment, then was suprised to hear him say almost immediately that it was a pilomatricoma, or benign hair follicle tumor. What's more, it would continue to grow, calcify and require surgical excision either now or later, but definitely sometime.

(picture: very not-so benign looking cyst or pilomatricoma in May)

The pilomatricoma is about an inch below her eye.  Given the location on the face and proximity to her eyes, I called the pediatric plastic surgeon at University of Michigan Mott Children's Hospital, although the dermatologist was comfortable doing it himself.   In the interim of our wait between dermatologist consult (May 3) and plastic surgeon consult (June 3)  the thing has gotten huge--nearly dime-size and angry red.  The skin has been stretched by its inflammation such that it appears to be flaking off over the top of the bump, and it generally looks like a nasty nasty bug bite (if it was on an adult, it could look like cystic acne, but one doesn't assume this on a three year old).  This inflammation has lasted nearly three weeks, much longer than the February flare up.  The June 3 plastic surgery consult, with Dr. Steven Kasten, can't come soon enough.