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This 10-year-old girl noted a growth in the outer corner of her right eye approximately 2 months ago. The lesion has been growing ever since.  There is no pain or tenderness.  The mass is firm and not attached to the underlying bone. She denies any other associated symptoms. She is otherwise healthy and is not on any medications. Both the patient and the parents want the lesion to be removed.

1.	What is the next step?
	d -- None of the above. This is a firm, nontender lesion with no history of trauma or associated symptoms like fevers or chills. Patient is healthy otherwise. The lesion has been growing steadily. Because of a possibilty of abnormal growth an excisional or incisional biopsy is the most appropriate step, especially since the parents are willing to have this lesion removed.
2.	What is the most appropriate step for diagnosis?
	b -- The lesion is mobile and non tender.  The location and time course of this lesion make it very unlikely that it would be a dermoid cyst.  These cysts are usually found either medially or laterally attached to the superior orbital rim.   There is clinically no apparent attachment of the lesion to the underlying bony structures. The most useful step for diagnosis (and cure) would be excisional biopsy.
3.	What is the most likley diagnosis for this lesion?
	d -- The lesion is firm, so it can not be a form of cyst. The location of the lesion is not appropriate for chalazion. The location and age for the lesion are also not appropriate for basal cell carcinoma. Although it is rare the most likely diagnosis for this case is a tumor of hair follicle origin. The diagnosis of pilomatrixoma was made after the patient received excisional biopsy. The lesion is benign and excision is curative.