Pilomatricoma is a benign neoplasm originating from epithelial hair matrix cells often found in hair bearing area. It has a bimodal age distribution, in the first and sixth decades. Although this tumor is not uncommon, in case old-aged patients where prevalence of pilomatricoma is low, accurate diagnosis is difficult due to possibility of other common tumors, including malignant neoplasms. A 89-year-old female patient presented with itchy crusted erythematous nodule on her glabella. The lesion appeared two to three months prior to the visit and recently grew in size. Under the impression of keratoacanthoma, partial wedge excision of the tumor wasperformed. The histopathologic examination was presented with pilomatricoma. Further total excision was performed, followed by a pathologic finding consistent with pilomatricoma and foreign body reaction. Previous study revealed that pilomatricoma are accurately diagnosed preoperatively in only 28-43% of cases. Due to this low accuracy, there are multiple studies on analysis of preoperative misdiagnosis of pilomatricoma. Even in these studies, however, keratoacantoma is rarely seen among the list of possible misdiagnosis, and only few case reports can be found worldwide. Herein we report a rare case of pilomatricoma clinically resembling keratoacanthoma.