What are sebaceous cysts. How do sebaceous cysts form on the upper back. What are the symptoms of sebaceous cysts. How are sebaceous cysts diagnosed and treated. Are sebaceous cysts dangerous or cancerous. Can sebaceous cysts be prevented. When should you see a doctor for a sebaceous cyst.

Understanding Sebaceous Cysts: What Are They and How Do They Form?

Sebaceous cysts, more accurately termed epidermoid cysts, are common benign skin growths that can develop on various parts of the body, including the upper back. These encapsulated, subepidermal nodules are filled with keratin, a protein that makes up hair and nails. Despite their name, sebaceous cysts don’t actually involve the sebaceous glands.

How do sebaceous cysts form? These cysts typically develop when the opening of a hair follicle becomes clogged or damaged. This can occur due to several factors:

• Trauma or injury to the skin
• Acne or other skin conditions
• Genetic predisposition
• Sun damage
• Certain medications

Once the follicle is blocked, dead skin cells and keratin accumulate beneath the skin’s surface, forming a cyst. Over time, these cysts can grow larger and may become noticeable or uncomfortable.

Identifying Sebaceous Cysts: Signs and Symptoms to Watch For

Recognizing a sebaceous cyst on your upper back or elsewhere on your body is crucial for proper management. What are the typical signs and symptoms of sebaceous cysts?

• A round, dome-shaped bump under the skin
• Slow growth over time
• Generally painless unless infected or ruptured
• A small, dark “punctum” or opening at the center of the cyst
• Mobility when pressed gently
• Possible foul odor if the cyst ruptures and drains

It’s important to note that while sebaceous cysts are usually harmless, they can occasionally become infected or inflamed. In such cases, you may experience redness, tenderness, warmth, or swelling around the cyst.

Diagnosing Sebaceous Cysts: What to Expect During a Medical Evaluation

If you suspect you have a sebaceous cyst on your upper back, how is it diagnosed? Typically, a healthcare provider can diagnose a sebaceous cyst through a physical examination. The process usually involves:

1. Visual inspection of the cyst
2. Palpation to assess the cyst’s characteristics
3. Discussion of your medical history and symptoms
4. In some cases, a biopsy may be performed to rule out other conditions

During the examination, your doctor will look for the characteristic features of a sebaceous cyst, such as its round shape, mobility, and the presence of a central punctum. They may also ask about any changes in the cyst’s size or appearance over time.

Differential Diagnosis: Ruling Out Other Conditions

While sebaceous cysts have distinct characteristics, other skin conditions can sometimes mimic their appearance. Your healthcare provider may consider the following in their differential diagnosis:

• Lipomas (benign fatty tumors)
• Pilar cysts
• Abscesses
• Boils
• Certain skin cancers

In rare cases, imaging studies such as ultrasound or MRI may be used to further evaluate the cyst and rule out other conditions.

Treatment Options for Sebaceous Cysts: From Conservative Management to Surgical Removal

How are sebaceous cysts treated? The appropriate treatment for a sebaceous cyst on the upper back depends on various factors, including the cyst’s size, location, and whether it’s causing discomfort or cosmetic concerns. Treatment options include:

1. Conservative Management

For small, asymptomatic cysts, a watch-and-wait approach may be recommended. This involves monitoring the cyst for any changes in size, appearance, or symptoms.

2. Incision and Drainage

If a cyst becomes infected or inflamed, your doctor may perform incision and drainage to relieve pressure and remove the cyst contents. However, this method doesn’t remove the cyst wall, so recurrence is possible.

3. Intralesional Corticosteroid Injection

For inflamed cysts, a corticosteroid injection can help reduce inflammation and shrink the cyst.

4. Surgical Excision

Complete surgical removal of the cyst, including its wall, is the most effective treatment to prevent recurrence. This is typically done under local anesthesia and may leave a small scar.

5. Minimal Excision Technique

This less invasive procedure involves making a small incision to remove the cyst contents and wall, resulting in minimal scarring.

The choice of treatment depends on individual circumstances and should be discussed with a healthcare provider.

Potential Complications of Sebaceous Cysts: When to Seek Medical Attention

While sebaceous cysts are generally benign, they can occasionally lead to complications. What are the potential risks associated with sebaceous cysts, and when should you seek medical attention?

• Infection: If a cyst becomes red, painful, or starts draining pus, it may be infected and require antibiotics.
• Rupture: A ruptured cyst can cause inflammation and increase the risk of infection.
• Scarring: Improper treatment or recurrent inflammation can lead to scarring.
• Discomfort: Large cysts or those in sensitive areas may cause discomfort or interfere with daily activities.
• Malignant transformation: Although rare, there is a small risk (about 1%) of sebaceous cysts developing into skin cancer.

Seek medical attention if you notice any of the following:

• Rapid growth or change in the cyst’s appearance
• Signs of infection (redness, warmth, pain, or pus drainage)
• A cyst that interferes with your daily activities
• Any concerns about the nature of the growth

Preventing Sebaceous Cysts: Can They Be Avoided?

While it’s not always possible to prevent sebaceous cysts, there are steps you can take to reduce your risk of developing them or experiencing complications:

1. Practice good skin hygiene to prevent blocked pores
2. Avoid picking or squeezing existing cysts to prevent infection
3. Protect your skin from excessive sun exposure
4. Manage underlying skin conditions like acne
5. Be cautious with activities that may cause trauma to the skin

It’s important to note that some individuals may be more prone to developing sebaceous cysts due to genetic factors or certain medical conditions. In these cases, prevention may be more challenging, but early detection and proper management can help minimize complications.

Living with Sebaceous Cysts: Management and Quality of Life Considerations

For many people, sebaceous cysts on the upper back or other parts of the body are a minor inconvenience. However, they can sometimes impact quality of life, especially if they’re large, visible, or prone to infection. How can you manage living with sebaceous cysts?

Psychological Impact

Some individuals may feel self-conscious about visible cysts. If this is a concern, consider discussing treatment options with your healthcare provider or seeking support from a mental health professional.

Clothing Choices

If you have a large cyst on your upper back, you may need to be mindful of clothing choices to avoid irritation. Loose-fitting, breathable fabrics can help reduce friction and discomfort.

Activity Modifications

Depending on the location and size of the cyst, you may need to modify certain activities to prevent irritation or rupture. For example, you might need to adjust your backpack straps or avoid certain exercises that put pressure on the cyst.

Regular Monitoring

Keep an eye on your cysts and perform regular self-examinations to detect any changes early. This can help you catch potential complications before they become serious.

Open Communication

Maintain open communication with your healthcare provider about your concerns and any changes you notice in your cysts. This can help ensure appropriate management and timely intervention if needed.

Sebaceous Cysts in Special Populations: Considerations for Different Age Groups and Medical Conditions

While sebaceous cysts can affect anyone, certain populations may have unique considerations when it comes to diagnosis, treatment, and management. How do sebaceous cysts present in different age groups or medical conditions?

Sebaceous Cysts in Children

Sebaceous cysts are relatively rare in children before puberty. When they do occur, they may be associated with certain genetic conditions. If a child develops multiple cysts or cysts in unusual locations, further evaluation may be warranted.

Sebaceous Cysts in Older Adults

In older adults, sebaceous cysts may be more common due to cumulative sun damage and changes in skin elasticity. The Favre-Racouchot syndrome, characterized by cysts and comedones in sun-damaged skin, is particularly prevalent in this age group.

Sebaceous Cysts in Pregnancy

Hormonal changes during pregnancy can sometimes lead to the development or growth of sebaceous cysts. Treatment options may be limited during pregnancy, and a conservative approach is often preferred unless complications arise.

Sebaceous Cysts in Individuals with Chronic Conditions

People with certain chronic conditions or those taking specific medications may be more prone to developing sebaceous cysts. For example:

• Patients on BRAF inhibitors for cancer treatment may develop facial cysts
• Individuals with acne vulgaris may be more likely to develop multiple cysts
• Those with Gardner syndrome or Gorlin syndrome may develop cysts as part of their condition

In these cases, management of sebaceous cysts should be coordinated with the patient’s overall care plan and may require a multidisciplinary approach.

Emerging Research and Future Directions in Sebaceous Cyst Management

As medical science advances, new insights and treatment options for sebaceous cysts continue to emerge. What are some of the latest developments and future directions in sebaceous cyst research and management?

Genetic Studies

Researchers are investigating the genetic factors that may predispose individuals to develop sebaceous cysts. This could lead to improved risk assessment and prevention strategies in the future.

Novel Treatment Approaches

New minimally invasive techniques for cyst removal are being explored, aiming to reduce scarring and recovery time. These include laser-assisted drainage and cryotherapy.

Immunological Insights

Studies are examining the role of the immune system in cyst formation and inflammation. This could potentially lead to new immunomodulatory treatments for managing cysts.

Malignancy Risk Assessment

Ongoing research is focusing on better understanding the rare instances of malignant transformation in sebaceous cysts. This could help develop more accurate risk assessment tools and guide treatment decisions.

Topical Treatments

Researchers are exploring the potential of topical medications to shrink or prevent sebaceous cysts, which could offer a non-invasive treatment option in the future.

As research progresses, it’s likely that our understanding and management of sebaceous cysts will continue to evolve, potentially offering patients more effective and less invasive treatment options in the years to come.

Epidermoid Cyst – StatPearls – NCBI Bookshelf

Patrick M. Zito; Richard Scharf.

Author Information and Affiliations

Last Update: March 7, 2023.

Continuing Education Activity

Epidermoid cysts, also known as a sebaceous cysts, are encapsulated subepidermal nodules filled with keratin. Although most commonly located on the face, neck, and trunk, epidermoid cysts can form anywhere on the body. Sebaceous cysts are generally considered to be benign, however new evidence indicates that they can develop de novo malignancy. This activity reviews the presentation, evaluation, and management of sebaceous cysts and highlights the role of the interprofessional team caring for patients affected by this condition.

Objectives:

• Identify the etiology of sebaceous cysts.

• Describe the typical presentation of a patient with a sebaceous cyst.

• Review the management options available for sebaceous cysts.

• Describe interprofessional team strategies to improve care coordination and management for patients with sebaceous cysts.

Access free multiple choice questions on this topic.

Introduction

Epidermoid cyst, also known as a sebaceous cyst, is a benign encapsulated, subepidermal nodule filled with keratin material.  Although most commonly located on the face, neck, and trunk, epidermoid cysts can be found anywhere including the scrotum, genitalia, fingers, and cases within the buccal mucosa. Cysts may progress slowly and remain present for years. The term sebaceous cyst is commonly used; however, the term is a misnomer in that it does not involve the sebaceous gland. Epidermoid cysts develop within the infundibulum. Other common synonyms include infundibular cyst, epidermal cyst, and epidermal inclusion cyst. Although these cysts are recognized as benign lesions, rare malignancy can arise.[1][2][3]

Etiology

The majority of cases are of epidermoid cysts are sporadic. Although epidermoid cysts can be found in autosomal dominant (AD) Gardner syndrome (familial adenomatous polyposis) and Gorlin syndrome (basal cell nevus syndrome). Epidermoid cysts occurring before puberty in unusual locations and numbers raise the suspicion of a syndrome. In Favre-Racouchot syndrome (nodular elastosis with cysts and comedones) in elderly patients, epidermoid cysts may result from chronic sun damage. Patients on BRAF inhibitors can develop epidermoid cysts of the face. Lately, imiquimod and cyclosporine have been noted to cause epidermal inclusion cysts.[4][5][6]

Epidemiology

Epidermoid cysts are the most common cutaneous cysts and typically occur in the third and fourth decades of life. It is rare to find these cysts before puberty. They are predominantly found in males versus females (ratio 2:1). In the neonatal period, small epidermal cysts, referred to as milia, are common. Approximately 1% of epidermoid cysts have been noted to have a malignant transformation to squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).

Pathophysiology

Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.

Histopathology

Stratified squamous epithelium lines the cyst. Histological examination reveals an epithelial-lined cyst filled with laminated keratin located within the dermis. The lining of the cyst is similar to the surface epithelium but differs in that it lacks rete ridges.  A granular layer is present that is filled with keratohyalin granules.

History and Physical

Physical examination generally reveals a 0.5 cm to several centimeters of non-fluctuant, compressible mass. A central, dark comedone opening (punctum) is often described. Epidermoid cysts are usually asymptomatic; however, if ruptured it may closely resemble a furuncle with tenderness to palpation, erythema, and swelling. A foul-smelling yellowish cheese-like material discharged from the skin may be described. Some patients may describe an event of a fall on their back or someone slapping their back causing painful swelling and the resulting cystic rupture. Epidermoid cysts can be found anywhere but are commonly found on the face, neck, chest, upper back, scrotum, and genitals. They can also be found on the buttocks, palms, and plantar side of feet if due to penetrating trauma. If occurring on the distal portion of the fingers, changes to the nail plate may occur. Taking a good history can aid in determining if the cyst is an isolated case, caused by medications, or if it is part of a genetic syndrome.

Evaluation

Evaluation of epidermoid cysts is based largely upon history and physical. The need for histological examination of the excised mass is often debated. Laboratory examination is not necessary. Radiographic tests are not commonly utilized in the evaluation of epidermoid cysts.

Treatment / Management

The most effective treatment involves complete surgical excision of the cyst with the cyst wall intact. The complete excision should be delayed if an active infection is present as the planes of dissection will be difficult. In these cases an initial incision and drainage may be indicated with a potential for reoccurrence in the future A local anesthetic with epinephrine is preferred to minimize bleeding. The anesthetic should be injected around the cyst, with avoidance of direct injection into the cyst. A small diameter elliptical incision with the inclusion of the central core, or punctum can be utilized. For optimal cosmetic results, maintaining the incision in the minimal skin tension lines is important. A multiple-layered subcuticular and epidermal closure will yield an optimal outcome. An alternative surgical approach can also be done with a punch biopsy and expulsion of the intact cyst through the small defect or standard excision. If there is surrounding inflammation, intralesional triamcinolone may be used to help decrease inflammation in addition to a delay in surgical removal. If the cyst has ruptured and the lining destroyed, the cyst will not reoccur. However, removing of the entire cystic lining is important in decreasing recurrence.[7][8][9]

Differential Diagnosis

Depending on location, the differential diagnoses of epidermoid cysts include the following: lipoma, dermoid cyst, pilar cyst (isthmus-catagen cyst, trichilemmal, wen), furuncle, branchial cleft cyst, milia, pilonidal cyst, calcinosis cutis, Pachyonychia Congenita, steatocystoma, and cutaneous findings of Gardner syndrome.

Prognosis

Epidermal inclusion cysts are recognized as benign cysts. However, rare malignancy can occur. Squamous cell carcinoma (SCC) is the most common malignancy followed by basal cell carcinoma (BCC).  In developing malignancy, squamous cell carcinoma occurs approximately 70% of the time.

Complications

Complications of rupture include erythema, swelling, and pain. Complications of surgical removal include bleeding, infection, and scaring. Erythema and pain can be managed with intralesional triamcinolone. Infection following surgery can be prevented using proper aseptic techniques. While recognized as a benign cyst, rare malignancy may occur.

Postoperative and Rehabilitation Care

Following surgical excision, it appropriate to avoid contact sports and strenuous activity. Sutures may be removed within 7-10 days. Patients should be instructed on the fact that the surgical scar will generally take 8 weeks to reach a maximum of 80% tensile strength of the original skin strength. Scar revision, if necessary, should take place between 6 months to 1 year following excision as the remodeling phase of wound healing occurs between 3 weeks to 1 year.

Consultations

Consultations are not necessary unless the cyst is large and in an unusual location such as the mouth or face. In those circumstances, specialist consultation may be warranted. Adults with epidermoid cysts in rare locations such as the fingers and toes, history of multiple lipomas, and a family history of colon cancer should raise the suspicion of Gardner syndrome with an appropriate specialist referral.

Pearls and Other Issues

Epidermoid cysts (sebaceous cysts) are common benign encapsulated cysts. Due to the inflammatory reaction from the release of keratin contents, many practitioners will mistake the cyst for an abscess and prescribe antibiotics.

Enhancing Healthcare Team Outcomes

Epidermal cysts are commonly encountered by the primary care provider, dermatologist, nurse practitioner, surgeon and the internist. While the majority of these cysts are benign, it is important to send the excised sample for evaluation to ensure that there is no malignancy. 

When completely excised, the outcomes are excellent. However, recurrences are common in patients with genetic syndromes.[10]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Epidermoid Cysts. Contributed by Dr. Shyam Verma, MBBS, DVD, FRCP, FAAD, Vadodara, India

References

1.

Kasahara R, Tajiri R, Kobayashi K, Yao M, Kitami K. Squamous Cell Carcinoma Developing from a Testicular Epidermal Cyst: A Case Report and Literature Review. Case Rep Urol. 2019;2019:9014301. [PMC free article: PMC6451811] [PubMed: 31019832]

2.

Birge O, Erkan MM, Serin AN. Case report: epidermoid inclusion cyst of the clitoris as a long-term complication of female genital mutilation. J Med Case Rep. 2019 Apr 27;13(1):109. [PMC free article: PMC6486694] [PubMed: 31027516]

3.

Kim SJ, Kim WG. Clinical and Imaging Features of a Ruptured Epidermal Inclusion Cyst in the Subareolar Area: A Case Report. Am J Case Rep. 2019 Apr 24;20:580-586. [PMC free article: PMC6501737] [PubMed: 31015391]

4.

Bashaireh KM, Audat ZA, Jahmani RA, Aleshawi AJ, Al Sbihi AF. Epidermal inclusion cyst of the knee. Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1355-1358. [PubMed: 30968204]

5.

Balasundaram P, Garg A, Prabhakar A, Joseph Devarajan LS, Gaikwad SB, Khanna G. Evolution of epidermoid cyst into dermoid cyst: Embryological explanation and radiological-pathological correlation. Neuroradiol J. 2019 Apr;32(2):92-97. [PMC free article: PMC6410456] [PubMed: 30604653]

6.

Ma J, Jia G, Jia W. Primary intradiploic epidermoid cyst: A case report with literature review. Clin Neuropathol. 2019 Jan/Feb;38(1):28-32. [PubMed: 30526818]

7.

Weir CB, St. Hilaire NJ. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 12, 2023. Epidermal Inclusion Cyst. [PubMed: 30335343]

8.

Prior A, Anania P, Pacetti M, Secci F, Ravegnani M, Pavanello M, Piatelli G, Cama A, Consales A. Dermoid and Epidermoid Cysts of Scalp: Case Series of 234 Consecutive Patients. World Neurosurg. 2018 Dec;120:119-124. [PubMed: 30189303]

9.

Frank E, Macias D, Hondorp B, Kerstetter J, Inman JC. Incidental Squamous Cell Carcinoma in an Epidermal Inclusion Cyst: A Case Report and Review of the Literature. Case Rep Dermatol. 2018 Jan-Apr;10(1):61-68. [PMC free article: PMC5903124] [PubMed: 29681810]

10.

Li J, Qian M, Huang X, Zhao L, Yang X, Xiao J. Repeated recurrent epidermoid cyst with atypical hyperplasia: A case report and literature review. Medicine (Baltimore). 2017 Dec;96(49):e8950. [PMC free article: PMC5728879] [PubMed: 29245264]

Disclosure: Patrick Zito declares no relevant financial relationships with ineligible companies.

Disclosure: Richard Scharf declares no relevant financial relationships with ineligible companies.

Epidermoid Cyst – StatPearls – NCBI Bookshelf

Patrick M. Zito; Richard Scharf.

Author Information and Affiliations

Last Update: March 7, 2023.

Continuing Education Activity

Epidermoid cysts, also known as a sebaceous cysts, are encapsulated subepidermal nodules filled with keratin. Although most commonly located on the face, neck, and trunk, epidermoid cysts can form anywhere on the body. Sebaceous cysts are generally considered to be benign, however new evidence indicates that they can develop de novo malignancy. This activity reviews the presentation, evaluation, and management of sebaceous cysts and highlights the role of the interprofessional team caring for patients affected by this condition.

Objectives:

• Identify the etiology of sebaceous cysts.

• Describe the typical presentation of a patient with a sebaceous cyst.

• Review the management options available for sebaceous cysts.

• Describe interprofessional team strategies to improve care coordination and management for patients with sebaceous cysts.

Access free multiple choice questions on this topic.

Introduction

Epidermoid cyst, also known as a sebaceous cyst, is a benign encapsulated, subepidermal nodule filled with keratin material.  Although most commonly located on the face, neck, and trunk, epidermoid cysts can be found anywhere including the scrotum, genitalia, fingers, and cases within the buccal mucosa. Cysts may progress slowly and remain present for years. The term sebaceous cyst is commonly used; however, the term is a misnomer in that it does not involve the sebaceous gland. Epidermoid cysts develop within the infundibulum. Other common synonyms include infundibular cyst, epidermal cyst, and epidermal inclusion cyst. Although these cysts are recognized as benign lesions, rare malignancy can arise. [1][2][3]

Etiology

The majority of cases are of epidermoid cysts are sporadic. Although epidermoid cysts can be found in autosomal dominant (AD) Gardner syndrome (familial adenomatous polyposis) and Gorlin syndrome (basal cell nevus syndrome). Epidermoid cysts occurring before puberty in unusual locations and numbers raise the suspicion of a syndrome. In Favre-Racouchot syndrome (nodular elastosis with cysts and comedones) in elderly patients, epidermoid cysts may result from chronic sun damage. Patients on BRAF inhibitors can develop epidermoid cysts of the face. Lately, imiquimod and cyclosporine have been noted to cause epidermal inclusion cysts.[4][5][6]

Epidemiology

Epidermoid cysts are the most common cutaneous cysts and typically occur in the third and fourth decades of life. It is rare to find these cysts before puberty. They are predominantly found in males versus females (ratio 2:1). In the neonatal period, small epidermal cysts, referred to as milia, are common. Approximately 1% of epidermoid cysts have been noted to have a malignant transformation to squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).

Pathophysiology

Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.

Histopathology

Stratified squamous epithelium lines the cyst. Histological examination reveals an epithelial-lined cyst filled with laminated keratin located within the dermis. The lining of the cyst is similar to the surface epithelium but differs in that it lacks rete ridges.  A granular layer is present that is filled with keratohyalin granules.

History and Physical

Physical examination generally reveals a 0.5 cm to several centimeters of non-fluctuant, compressible mass. A central, dark comedone opening (punctum) is often described. Epidermoid cysts are usually asymptomatic; however, if ruptured it may closely resemble a furuncle with tenderness to palpation, erythema, and swelling. A foul-smelling yellowish cheese-like material discharged from the skin may be described. Some patients may describe an event of a fall on their back or someone slapping their back causing painful swelling and the resulting cystic rupture.  Epidermoid cysts can be found anywhere but are commonly found on the face, neck, chest, upper back, scrotum, and genitals. They can also be found on the buttocks, palms, and plantar side of feet if due to penetrating trauma. If occurring on the distal portion of the fingers, changes to the nail plate may occur. Taking a good history can aid in determining if the cyst is an isolated case, caused by medications, or if it is part of a genetic syndrome.

Evaluation

Evaluation of epidermoid cysts is based largely upon history and physical. The need for histological examination of the excised mass is often debated. Laboratory examination is not necessary. Radiographic tests are not commonly utilized in the evaluation of epidermoid cysts.

Treatment / Management

The most effective treatment involves complete surgical excision of the cyst with the cyst wall intact. The complete excision should be delayed if an active infection is present as the planes of dissection will be difficult. In these cases an initial incision and drainage may be indicated with a potential for reoccurrence in the future A local anesthetic with epinephrine is preferred to minimize bleeding. The anesthetic should be injected around the cyst, with avoidance of direct injection into the cyst. A small diameter elliptical incision with the inclusion of the central core, or punctum can be utilized. For optimal cosmetic results, maintaining the incision in the minimal skin tension lines is important. A multiple-layered subcuticular and epidermal closure will yield an optimal outcome. An alternative surgical approach can also be done with a punch biopsy and expulsion of the intact cyst through the small defect or standard excision. If there is surrounding inflammation, intralesional triamcinolone may be used to help decrease inflammation in addition to a delay in surgical removal. If the cyst has ruptured and the lining destroyed, the cyst will not reoccur. However, removing of the entire cystic lining is important in decreasing recurrence. [7][8][9]

Differential Diagnosis

Depending on location, the differential diagnoses of epidermoid cysts include the following: lipoma, dermoid cyst, pilar cyst (isthmus-catagen cyst, trichilemmal, wen), furuncle, branchial cleft cyst, milia, pilonidal cyst, calcinosis cutis, Pachyonychia Congenita, steatocystoma, and cutaneous findings of Gardner syndrome.

Prognosis

Epidermal inclusion cysts are recognized as benign cysts. However, rare malignancy can occur. Squamous cell carcinoma (SCC) is the most common malignancy followed by basal cell carcinoma (BCC).  In developing malignancy, squamous cell carcinoma occurs approximately 70% of the time.

Complications

Complications of rupture include erythema, swelling, and pain. Complications of surgical removal include bleeding, infection, and scaring. Erythema and pain can be managed with intralesional triamcinolone. Infection following surgery can be prevented using proper aseptic techniques. While recognized as a benign cyst, rare malignancy may occur.

Postoperative and Rehabilitation Care

Following surgical excision, it appropriate to avoid contact sports and strenuous activity. Sutures may be removed within 7-10 days. Patients should be instructed on the fact that the surgical scar will generally take 8 weeks to reach a maximum of 80% tensile strength of the original skin strength. Scar revision, if necessary, should take place between 6 months to 1 year following excision as the remodeling phase of wound healing occurs between 3 weeks to 1 year.

Consultations

Consultations are not necessary unless the cyst is large and in an unusual location such as the mouth or face. In those circumstances, specialist consultation may be warranted. Adults with epidermoid cysts in rare locations such as the fingers and toes, history of multiple lipomas, and a family history of colon cancer should raise the suspicion of Gardner syndrome with an appropriate specialist referral.

Pearls and Other Issues

Epidermoid cysts (sebaceous cysts) are common benign encapsulated cysts. Due to the inflammatory reaction from the release of keratin contents, many practitioners will mistake the cyst for an abscess and prescribe antibiotics.

Enhancing Healthcare Team Outcomes

Epidermal cysts are commonly encountered by the primary care provider, dermatologist, nurse practitioner, surgeon and the internist. While the majority of these cysts are benign, it is important to send the excised sample for evaluation to ensure that there is no malignancy. 

When completely excised, the outcomes are excellent. However, recurrences are common in patients with genetic syndromes.[10]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Epidermoid Cysts. Contributed by Dr. Shyam Verma, MBBS, DVD, FRCP, FAAD, Vadodara, India

References

1.

Kasahara R, Tajiri R, Kobayashi K, Yao M, Kitami K. Squamous Cell Carcinoma Developing from a Testicular Epidermal Cyst: A Case Report and Literature Review. Case Rep Urol. 2019;2019:9014301. [PMC free article: PMC6451811] [PubMed: 31019832]

2.

Birge O, Erkan MM, Serin AN. Case report: epidermoid inclusion cyst of the clitoris as a long-term complication of female genital mutilation. J Med Case Rep. 2019 Apr 27;13(1):109. [PMC free article: PMC6486694] [PubMed: 31027516]

3.

Kim SJ, Kim WG. Clinical and Imaging Features of a Ruptured Epidermal Inclusion Cyst in the Subareolar Area: A Case Report. Am J Case Rep. 2019 Apr 24;20:580-586. [PMC free article: PMC6501737] [PubMed: 31015391]

4.

Bashaireh KM, Audat ZA, Jahmani RA, Aleshawi AJ, Al Sbihi AF. Epidermal inclusion cyst of the knee. Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1355-1358. [PubMed: 30968204]

5.

Balasundaram P, Garg A, Prabhakar A, Joseph Devarajan LS, Gaikwad SB, Khanna G. Evolution of epidermoid cyst into dermoid cyst: Embryological explanation and radiological-pathological correlation. Neuroradiol J. 2019 Apr;32(2):92-97. [PMC free article: PMC6410456] [PubMed: 30604653]

6.

Ma J, Jia G, Jia W. Primary intradiploic epidermoid cyst: A case report with literature review. Clin Neuropathol. 2019 Jan/Feb;38(1):28-32. [PubMed: 30526818]

7.

Weir CB, St.Hilaire NJ. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 12, 2023. Epidermal Inclusion Cyst. [PubMed: 30335343]

8.

Prior A, Anania P, Pacetti M, Secci F, Ravegnani M, Pavanello M, Piatelli G, Cama A, Consales A. Dermoid and Epidermoid Cysts of Scalp: Case Series of 234 Consecutive Patients. World Neurosurg. 2018 Dec;120:119-124. [PubMed: 30189303]

9.

Frank E, Macias D, Hondorp B, Kerstetter J, Inman JC. Incidental Squamous Cell Carcinoma in an Epidermal Inclusion Cyst: A Case Report and Review of the Literature. Case Rep Dermatol. 2018 Jan-Apr;10(1):61-68. [PMC free article: PMC5903124] [PubMed: 29681810]

10.

Li J, Qian M, Huang X, Zhao L, Yang X, Xiao J. Repeated recurrent epidermoid cyst with atypical hyperplasia: A case report and literature review. Medicine (Baltimore). 2017 Dec;96(49):e8950. [PMC free article: PMC5728879] [PubMed: 29245264]

Disclosure: Patrick Zito declares no relevant financial relationships with ineligible companies.

Disclosure: Richard Scharf declares no relevant financial relationships with ineligible companies.

Spinal cyst removal (facet joints)

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Surgery to remove a spinal cyst is considered the only effective method of treatment at advanced stages of the disease, when it comes to paraarticular synovial cyst of the intervertebral facet joint. As a rule, this condition is accompanied by pain in the arm or leg, sometimes with numbness. In some medical cases, the pain syndrome is so unbearable that the patient may need emergency spinal surgery.

Cyst of the intervertebral (facet) joints is a benign formation in the cavity of which fluid accumulates. Over time, it increases in size and causes severe pain. Experts classify a spinal cyst as a rare pathology, but recommend not to start the disease and seek help from neurosurgeons in time if symptoms are present.

Spinal cyst symptoms

Depending on the location of the cysts of the spine can be divided into:

• Cysts in the cervical spine;
• Cysts in the thoracic spine;
• Cysts in the lumbar spine;
• Cysts in the lumbosacral spine;
• Cysts in the sacral spine.

According to the nature of education, specialists distinguish the following types:

• Perineural cyst of the spine (usually an incidental finding and does not require treatment)
• Para-articular cyst (para-articular synovial cyst of the intervertebral facet joint, requires spinal surgery)
• Arachnoid cyst (very rare)

According to experts, there are dozens of varieties of spinal cysts, most of which are considered the norm . Surgical treatment is indicated for a paraarticular synovial cyst of the intervertebral facet joint if radicular compression symptoms are observed. In practice, this means that the patient suffers from regular pain in the localization of the cyst of the spine and in the limbs. Often, the discomfort is accompanied by numbness in the arm or leg. If the pain becomes unbearable, then emergency surgery is recommended.

Spinal cyst treatment

The most modern method for diagnosing spinal cysts is MRI. It is worth noting that in order to obtain an accurate diagnosis, it is necessary to take a picture of 1.5 Tesla. Most cysts do not cause discomfort, so patients live with them for years. Conservative treatment by a neurologist is indicated for back pain with a perineural cyst of the spine. To eliminate the pain syndrome, specialists prescribe a course of injections.

Spinal cyst surgery

As already mentioned, most often surgery is indicated for paraarticular synovial cyst of the intervertebral facet joint. Many patients consider laser removal of a spinal cyst to be the most effective method, but neurosurgeons refute the effectiveness of such an operation. When removing a spinal cyst with a laser, a heat wave adversely affects the vertebral discs, destroying them. Therefore, it has already been experimentally proven that the method of removing a spinal cyst with a laser is noticeably outdated.

Endoscopic removal of a cyst of the spine (facet joint)

Minimally invasive endoscopic spinal surgery is performed in case of paraarticular synovial cyst of the intervertebral facet joint if appropriate symptoms are present. Surgical intervention takes place under general anesthesia for 1-1.5 hours. The neurosurgeon performs all manipulations through small punctures, which has a positive effect on recovery.

Recovery after removal of a spinal cyst

After the operation to remove the cyst of the spine, the patient is discharged from the clinic the next day, and he can return to his normal life. Recovery after endoscopic spinal surgery does not involve bed rest, but it is worth limiting yourself to lifting weights and playing sports.

Why is it worth having an operation to remove a spinal cyst in the Pirogov Clinic?

• Neurosurgeons of the highest category, with more than 10 years of experience, with a scientific degree of med. Sciences.
• Modern equipment in operating rooms.
• Affordable prices for the removal of a cyst of the spine.
• Positive feedback about spinal surgery and treatment in our clinic. You can view them on our website, as well as on independent sites, such as Napopravku.ru.
• Hospital type wards.
• You can get a neurosurgeon’s recommendation on the treatment of your disease absolutely free of charge. You can send MRI images on this page of the site.
• The possibility of obtaining an installment plan or a loan for treatment.
• Service under VHI policies.

WANT TO ASK A QUESTION ABOUT YOUR OCCASION? SEND YOUR MRI IMAGES

How to describe your complaints correctly:

1. Describe in detail: the nature and localization of pain; the presence and localization of numbness and weakness in the limbs; conditions for the onset or intensification of pain; the presence of morning stiffness in the back; whether there is relief after “pacing”; whether the pain gets worse after prolonged sitting or standing; what worries more pain in the back / neck or leg / arm, it is desirable to evaluate both on a 10-point scale; whether the pain increases after flexion-extension; Is there relief after rest? whether there is an increase / increase in weakness / numbness in the legs after walking a certain distance with relief after stopping and bending or sitting down; is there a temperature; Is there an increase in pain at night and so on.
2. Medical history: duration of the disease, provoking factors, what you attribute the onset of the disease to, the treatment being carried out, the dynamics of the condition.
3. Presence of other diseases.
4. What hinders you the most? what would you like to get rid of? What are your expectations from the operation, if it is necessary?

How to send MRI images correctly

MRI images (not a doctor’s report, but images) must be on a disk, made on a device with a magnetic field voltage of at least 1.5 Tesla.

1. Insert disc into CD-ROM.
2. Copy folder with pictures in one file ENTIRELY to computer (right mouse button).
3. Name the copied file with your last name.
4. Add file to archive (right mouse button).
5. To upload MRI images (DICOM files), use an external cloud storage, such as Yandex Disk, Dropbox or Google Drive. Paste in the field above the link to the file or archive from the cloud storage.

Your images will be sent to our neurosurgeon Mereji Amir Mratovich.

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Pirogov Clinic

Neck cyst – signs, causes and methods of treatment in “SM-Clinic”

This disease is treated by a Surgeon

• About the disease
• Species
• Neck cyst symptoms
• Causes of neck cysts
• Neck cyst diagnostics
• Neck cyst treatment
• Prophylaxis
• Rehabilitation
• Questions and answers
• Doctors

About the disease

Recently, congenital anomalies of the neck and face have become more common, which may be due to poor environmental conditions (primarily worsening background radiation). Lateral soft tissue cysts are usually diagnosed immediately after birth (often combined with the presence of a fistulous tract), median cysts are diagnosed several years later.

Cervical cysts are not only an aesthetic defect. The inconvenience is also associated with the presence of pathological discharge from the fistula, painful sensations when swallowing. In some cases, neck cysts are accompanied by the development of inflammation. In 1-2% of patients there is also a risk of malignant degeneration.

Treatment involves surgery. Puncture and introduction of sclerosants into the cyst cavity is not very effective.

Species

According to the classification, the following types of neck cysts are distinguished:

• median (central) – located along the central vertical of the neck;
• lateral (lateral) – localized on the right or left.

Congenital cysts of the neck are often accompanied by fistulas. If the fistulous canal has 2 openings (one opens on the skin of the anterior surface of the neck, and the other on the mucous membrane of the oral cavity), then it is complete. A fistula is considered incomplete when there is only 1 fistula.

Neck cyst symptoms

Lateral neck cysts are more common than median cysts. Often they are asymptomatic for a long time. The tumor-like formation usually becomes well visualized when the head is turned to the side contralateral to the cyst. Cystic formation is usually elastic to the touch, not soldered to the surrounding tissues. Subjective symptoms of neck cysts with lateral localization usually appear when the contents are suppurated or when the formation is large, when there is compression of the large vessels and nerves of the neck.

Central cysts are usually located in the space between the superior surface of the thyroid cartilage and the hyoid bone. The position of the cyst can vary, being somewhat away from the midline, above the hyoid bone, below the upper edge of the thyroid cartilage.

Median cysts of the neck are usually round, elastic to the touch and little mobile. They move a little when swallowing. In the absence of complications, the skin over the cyst is not changed, while the skin can be taken in a fold. When feeling the formation of pain is absent. As a rule, the size of the central cysts is usually 20-40 mm. With suppuration of the median cyst, the likelihood of the formation of a fistulous tunnel increases. Fistulas are formed when pus finds a way out (the fistulous opening is located on the front surface of the neck. Fistulous discharge can periodically irritate the skin and lead to its maceration.

Causes of a cyst in the neck

Causes of a cyst in the neck are associated with a deviation from the normal course of the embryonic period.

• Lateral cysts. It is believed that their formation is due to the non-closure of the gill furrows. As a rule, this pathological process is associated with the action of unfavorable factors on the embryo at the 4-6th week of development.
• Median cysts. It is believed that they develop as a result of a delay in the reverse development (reduction) of the prenatal existing thyroid duct (it extends from the blind opening of the tongue to the thyroid gland). If this duct does not undergo reverse development, then it can transform into derivatives such as the pyramidal process of the thyroid gland, accessory thyroid glands, cysts and fistulas. The impact of unfavorable factors on the embryo at the 6-7th week of development creates prerequisites for the formation of median cysts.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

To learn more about the disease, prices for treatment and sign up for a consultation with a specialist, you can call:

+7 (495) 292-39-72

Request a call back
Book online

Why SM-Clinic?

1

Treatment is carried out in accordance with clinical guidelines

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

4

High level of service and balanced pricing policy

Neck cyst diagnostics

In order to diagnose and differential diagnosis of cysts and fistulas of the neck, paraclinical studies are carried out to exclude the specific nature of the pathological formations of the anterior surface of the neck.

• Contrast radiography – allows you to determine the size of the cyst, the nature of its structure, the presence of lateral branches, connection with the hyoid bone.
• Ultrasound scanning – ultrasound shows the size of the formation, its structure and connection with nearby organs.
• Computed (CT) or magnetic resonance imaging (MRI) – performed in complex clinical cases and allows you to assess in detail what the cyst looks like and what signs are characteristic of it.
• Puncture and cytological examination of the contents.

The final diagnosis of neck cysts is based on imaging data. And sometimes a morphological assessment of the cellular composition is also required.

Expert opinion

Although central cysts and fistulas of the neck are prenatal anomalies, they are rarely detected immediately after birth. As a rule, they are diagnosed in childhood or adolescence, sometimes even in adulthood. This feature is due to the fact that the central cysts increase in size very slowly, usually within 8-10 years. As practice shows, most often the time interval from the onset of the first symptoms to the visit to the doctor is from 6 months to 3 years.

Shikhaleva Natalya Gennadievna

Traumatologist-orthopedist, plastic surgeon, doctor of the highest category, MD

Treatment of neck cysts

Treatment of neck cysts is performed surgically.

Conservative treatment

The introduction of sclerosing agents into the cyst cavity is not very effective, so this method is practically not used at present.

Surgical treatment

Recently, during operations to remove median cysts and fistulas of the neck, doctors began to use microsurgical technology. The method allows you to consider in more detail all possible branches of the fistulous tract or strand and radically excise them, isolate the fistula or cyst from soldered and scar tissue.

Prevention

Pregravid preparation and creation of optimal conditions for prolonging pregnancy (reducing the risk of infectious diseases in a pregnant woman, protection from radiation, providing the body of a pregnant woman with vitamins and minerals, avoiding the unreasonable use of drugs) can reduce the likelihood of formation of neck cysts.

Rehabilitation

After surgery, the patient is recommended to come for dressings and antiseptic treatment of the surgical wound. This helps to create optimal conditions for tissue repair and wound healing.

Questions and Answers

This condition is diagnosed and treated by a general surgeon, an orthopedic traumatologist, and in some cases, the assistance of an oral and maxillofacial surgeon is also required.

The contents of the cysts are viscous, opaque with a yellowish tinge. The inflammatory process to which cysts are subject leads to the formation of persistent fistulas. Very often, the inflammatory process in cysts is provoked by viral colds and foci of chronic infection of the pharynx (chronic tonsillitis, chronic pharyngitis, hypertrophy of the lingual tonsil). Neck cysts can also suppurate and undergo malignant transformation.

Bogdanov K.P. About median cysts and fistulas of the neck. Anatomical and topographic characteristics: author. dis. … cand. honey. Sciences. – M., 1963. – 14 p.

Kiselev A.S., Pazhetnev A.N. Branchiogenic brushes and fistulas of the neck and face // Ros. otorhinolaryngitis – 2007. – No. 5. – P. 91–94.

Shulga I. A., Zheleznov A. M., Shulga A. I. Median cysts and fistulas of the neck, their surgical treatment. – Orenburg, 2007. – 116 p.

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