Pilomatrixomas (benign epithelioma of Malherbe) are often located in the eyelid or eyebrow. Clinically the diagnosis is rarely made. Histologically, especially in partial biopsies, they can be confused with a basal cell carcinoma. We evaluated 17 tumors in 17 patients (19 months to 80 years old). The interval between the diagnosis and total excision of the mass ranged from 4 weeks to 2 years. The clinical misdiagnosis appeared to be related to the patient's age: A cystic dermoid (4x) was considered most frequently in children and sebaceous cyst or atheroma (5x) in patients of middle age. Further diagnoses were as follows: Chalazion, basal cell carcinoma or keratoacanthoma, epidermoid cyst, abscess, papilloma. Nine tumors showed calcifications that might be visible by X-ray examination. After a mean follow-up of 7.6 years no recurrence was observed. Pilomatrixoma should be included in the clinical differential diagnosis of subepidermal solid or cystic tumors, especially in the upper eyelid and eyebrow.