Dermoid Cyst Symptoms, Causes, Treatments

Written by WebMD Editorial Contributors

• Dermoid Cyst Overview
• Dermoid Cyst Causes
• When to Seek Medical Care
• Exams and Tests for Dermoid Cysts
• Dermoid Cyst Home Remedies
• Medical Treatment for Dermoid Cysts
• Outlook for Dermoid Cysts
• More

A dermoid cyst is a saclike growth that is present at birth. It contains structures such as hair, fluid, teeth, or skin glands that can be found on or in the skin.

Dermoid cysts grow slowly and are not tender unless ruptured. They usually occur on the face, inside the skull, on the lower back, and in the ovaries. Superficial dermoid cysts on the face usually can be removed without complications. Removal of other, more rare dermoid cysts requires special techniques and training. These rarer dermoid cysts occur in four major areas:

• Dermoid cysts in the brain: Dermoid cysts occur very rarely here. A neurosurgeon may need to remove them if they cause problems.
• Dermoid cysts in the nasal sinuses: These are also very rare. Only a handful of cases involving dermoid cysts located here are reported each year. Removal of these cysts is extremely complicated.
• Ovarian dermoid cysts: These growths can develop in a woman during their reproductive years. They can cause torsion, infection, rupture, and cancer. These dermoid cysts can be removed with either conventional surgery or laparoscopy (surgery that uses small incisions and specially designed instruments to enter the abdomen or pelvis).
• Dermoid cysts of the spinal cord: A sinus tract, which is a narrow connection from a deep pit in the skin, usually connects these very rare cysts to the skin surface. This type of dermoid cyst can become infected. Removal is often incomplete, but the outcome is usually excellent.

Dermoid cysts are caused when skin and skin structures become trapped during fetal development. Their cell walls are nearly identical to those of the outer skin and may contain multiple skin structures such as hair follicles, sweat glands, and sometimes hair, teeth, or nerves.

A doctor should be contacted in the following situations:

• A cyst becomes painful or inflamed.
• A cyst grows or changes color.
• Removal is desired for cosmetic reasons.

Typically, removing a dermoid cyst is not an emergency procedure. If a dermoid cyst ruptures, becomes inflamed, or causes pain or fever, a person should seek immediate medical advice. Depending on the severity of pain or discomfort, a person might also consider visiting a hospital’s emergency department.

Prior to removal of superficial dermoid cysts on the face, a person should know the difference between cysts and other facial growths.

• Because dermoid cysts stem from birth and grow slowly, a person usually notices them during childhood or early adulthood.
• Dermoid cysts are firm and painless unless ruptured.
• Dermoid cysts are not attached to the overlying skin.

In rare cases, a dermoid cyst extends into a structure deeper than skin, such as a facial cavity or an orbit. Some doctors recommend a CT scan or other imaging studies for these cases. This decision depends on the doctor’s suspicion of a deep-level cyst and after a determination of risk versus benefit.

Self-removal of facial cysts at home is not recommended, because the cyst will grow back if not completely removed. Chances of infection, bleeding, and other complications increase for people who remove dermoid cysts themselves, especially because the person may not be able to differentiate between a harmless growth and other, more serious skin growths.

To remove a dermoid cyst, the doctor will clean the area over which the cyst is located, inject a local anesthetic, and make an incision directly over the cyst and attempt remove it completely.

Barring the possible complications associated with any surgery, removal of a dermoid cyst usually results in complete recovery.

Top Picks

Symptoms, Diagnosis and Ablation Treatment

How are Dermoid Cysts Treated?

Traditionally, the only treatment option for a dermoid cyst was surgical removal of the cyst. If the dermoid cyst is in the bone, surgery includes:

• Making a skin incision
• Extending the incision down to access the bone
• Drilling or scraping the dermoid cyst cells out of the bone

In locations like the forehead and skull, surgical incisions can be wide due to the need to access and completely remove the cyst.

These therapeutic challenges led to the development of a minimally-invasive treatment  (percutaneous dermoid cyst drainage and ablation) offered by Interventional Radiology.

What is dermoid cyst ablation?

Dermoid cyst ablation is a minimally-invasive procedure in which a small needle and plastic sleeve are used to enter the dermoid cyst. The cyst is then drained of its contents and the wall of the cyst is killed (ablated). The body’s own “cleanup” mechanisms then remove the dead dermoid cyst cells during healing. The procedure leaves a scar the size of a freckle.

How is the procedure performed?

Dermoid cyst ablation begins with ultrasound guided puncture of the cyst using a small needle and tube. The cyst contents are then thinned by injection of a small amount of  medical detergent which “thins” the oily contents and allows drainage of the cyst. After removing the cyst contents, the skin cells lining the cyst are ablated with a small “coblation” needle. Using precise ultrasound guidance, the coblation needle tip is placed within the collapsed dermoid cyst and the coblation energy (plasma cloud) destroys the cells of the dermoid cyst.

How long will the dermoid cyst ablation take?

Dermoid cysts ablation is performed in less than 1 hour.

Are there any risks to the procedure?

The primary risk during dermoid cyst ablation is injury to the overlying skin. Skin is protected from injury by injection of sterile fluid that “lifts” the skin away from the coblation energy cloud, providing precise ablation of the dermoid cyst capsule without adjacent skin injury.

What happens after the procedure?

Once the dermoid cyst ablation procedure is completed, the body removes the dead dermoid cyst cells and heals the treatment site. If bone is involved with the dermoid cyst, the bone containing the ablated dermoid cyst heals and new bone forms to fill in the previous defect. New bone healing after dermoid cyst ablation may be seen in 2-3 months.

When can my child bathe?

Patients who have undergone dermoid cyst ablation may shower immediately following treatment. They are instructed to refrain from submerging the treated site in a bath for 5 days to allow full healing of the small skin opening used for access to the dermoid cyst.

Are there any activity restrictions?

Aside from keeping the treatment site clean, there are no activity restrictions following dermoid cyst ablation.

Will the dermoid cyst come back after the procedure?

Dermoid cyst ablation is successful in 95% of patients with one treatment session. A second treatment session may be required (5% of patients) if some part of the cyst survives the ablation or if injury to the dermoid cyst occurred prior to the treatment allowing some of the abnormal cells to grow adjacent to the treated area.

What can my child expect after treatment is complete? Any long-term effects?

Results observed in our patients since 2006 have been excellent. Patients report no significant post-procedure pain, treatment related mild swelling resolves in a couple days, and infections are prevented with antibiotics taken after the procedure.

What happens if a dermoid cyst is left untreated?

Dermoid cysts left untreated will continue to enlarge. If injured and the cyst wall is ruptured, the leaking cyst contents irritate the surrounding tissues causing pain, swelling, and possibly scarring. Untreated dermoid cysts may occasionally become infected, requiring treatment with antibiotics or more urgent surgical removal.

Why Nationwide Children’s?

The specialties of Interventional Radiology and Plastic Surgery expertly care for children with dermoid cysts.

• Meet our Interventional Radiology team
• Meet our Plastic and Reconstructive Surgery team

Need help scheduling an appointment at Nationwide Children’s?

Request an Appointment
or
Get a Second Opinion

SOFT TISSUES CYSTS OF THE MAXILLOFACIAL REGION.

A CLINICAL CASE OF A LARGE EPIDERMAL CYSTS Publishing House “CIRCULATION” – Editorum

According to literature sources, soft tissue cysts of the face and neck, being an actual problem of maxillofacial surgery, arouse the interest of scientists regarding the sources of their development and clinical and morphological features of the structure [4] . At the same time, the opinions of experts on the frequency of occurrence of this pathology in patients of different age groups differ [3].

Epithelial cysts of the skin in the projection of the head and neck are divided into several types depending on their microscopic structure. In children, epidermal (epidermoid) and dermoid cysts are most common. According to their clinical manifestations and treatment, they are almost equivalent.

Epidermal (epidermoid) cyst is an intradermal or subcutaneous cyst filled with horny masses that arose from the epidermis, most often from the hair follicle. This cyst is a malformation resulting from the lacing of the epidermis during embryogenesis. Epidermal cysts occur at any age, localized mainly on the head (superciliary, zygomatic, temporal, parotid-masticatory areas), trunk and upper limbs. Clinically, an epidermal cyst is a mobile, painless formation of a rounded shape, densely elastic consistency, 0.3–0.5 cm in size or more. The skin above it is usually not changed, hyperemia occurs when a secondary infection is attached (often with the formation of an abscess). Surgical treatment. Malignancy of the epidermoid cyst is extremely rare [2].

Dermoid cyst, or dermoid, is a congenital tumor-like cystic neoplasm that belongs to teratomas. Occurs when embryogenesis is disturbed in places of confluence and overgrowth of embryonic furrows and cavities, where epidermal folds going deep are formed. Contains elements of the ectoderm – sebaceous and sweat glands, hair, fatty inclusions. Often detected in early childhood and puberty, may manifest in adulthood. The most characteristic localization of dermoids is the floor of the oral cavity, temporal and paraorbital regions, nasolabial folds, and the scalp. Clinically, a dermoid cyst is a formation of a densely elastic consistency with clear boundaries, mobile in relation to the underlying tissues, painless, covered with skin of a normal color [2].

Congenital cysts of the neck is a pathology that accounts for about 5% of all neoplasms of the maxillofacial region. These include brachyogenic, thyroglossal, and dermoid cysts of the neck. Difficulties in their recognition and treatment are associated with the topographic and anatomical conditions of growth, often with an intimate relationship with vital organs, and most importantly, with their diversity. The clinical picture of morphologically heterogeneous neoplasms of the neck and the results of the use of additional research methods make it obvious that none of the methods used separately provides complete information for verifying the diagnosis. A comprehensive examination is required using a combination of various diagnostic methods: ultrasound, computed tomography or magnetic resonance imaging, morphological examination, as well as modern capabilities of cone beam computed tomography [1].

The purpose of study is to describe the frequency and structure, methods of diagnosis and treatment of soft tissue cysts of the maxillofacial region and neck, to demonstrate a clinical case of a large facial epidermoid cyst.

Materials and methods of research

A retrospective study was carried out according to the protocols of operating journals, case histories of patients with soft tissue cysts of the face and neck of the Department of Maxillofacial Surgery and Otorhinolaryngology of the State Budgetary Institution of Healthcare “SOKB No. 1” for 2018.

Research results and discussion

area and neck per year. Among the observed patients there were 42 women (53.8%) and 36 men (46.2%). At the age of 18 to 44 years – 48 people (61.5%), from 45 to 60 – 26 (33.3%) and from 61 to 75 – 4 (5.1%). The frequency of surgical interventions for various soft tissue cysts of the face and neck is presented in the table.

All observed patients were diagnosed at the prehospital stage on the basis of clinical signs, radiological examination methods (mainly CT). Morphologically, in all patients, the diagnosis was confirmed by cytological examination of the punctate. All patients underwent a planned cystectomy (in the case of median cysts of the neck with resection of the body of the hyoid bone). The postoperative period proceeded without complications.

Table

Surgical interventions for soft tissue cysts of the face and neck

Clinical case.

Patient S., 37 years old, consulted an maxillofacial surgeon at the consultative and diagnostic polyclinic of SOKB No. 1 with complaints about the presence of a formation in the superciliary and temporal region, limitation of movements of the upper eyelid and vision due to the presence of this education.

From the anamnesis of the disease, it was found that the formation had existed for about 10 years, slowly increased in size, did not hurt, did not inflame, only after reaching a large exchange, it began to cause inconvenience and aesthetic discomfort to the patient. Previously, she applied to a surgeon, an ophthalmologist, an oncologist at the place of residence, but she refused the proposed surgical treatment. From the anamnesis of life: hypertension stage 2, risk 2, obesity stage 2. In childhood, she had hepatitis A.

Objective examination data: satisfactory condition, clear consciousness, active position, skin and visible mucous membranes without features. The physique is hypersthenic. Body temperature is normal. Arterial pressure 125/80 mm. rt. Art. On the part of organs and systems – without features.

Local status. The configuration of the face was changed due to the presence of a neoplasm of the temporal, superciliary and partially zygomatic regions on the right (Fig. 1).

Fig. 1. Appearance of the patient

Formation of a spherical shape about 10 cm in diameter, soft-elastic consistency, with even, clear contours, movable relative to the underlying tissues, soldered to the skin covering it. The skin over the formation of physiological coloration, enhanced vascular pattern. The formation is painless on palpation, soldered to the skin of the upper eyelid, hanging down under its own weight, so the right eye is almost completely closed.

Results of additional examination methods

The size is larger than the sensor width (more than 60 mm). Conclusion: soft tissue tumor of the right temporal region, probably benign. Similar in structure and structure formation 30×14 mm in size on the dorsum of the right foot.

2. On CT (Fig. 2): in the soft tissues of the zygomatic-orbital zone, in the region of the brow on the right, a hypodense formation of a rounded shape 63x53x44 mm, with clear even contours, of a homogeneous structure, does not accumulate a contrast agent. Infiltration of surrounding tissues is not determined, the skin is not thickened. Destructive changes in the adjacent bones of the vault and the facial part of the skull are not determined. The right eyeball is slightly displaced medially. The shape and structure of the eyeballs is normal. Visible parts of the brain without features. Conclusion: cystic formation of the frontal region on the right. epidermal cyst?

Fig. 2. CT scan of the head with contrast enhancement

3. The results of the cytological examination of the punctate: smears show horny masses, the punctate was probably obtained from an epidermal cyst.

In a planned manner with a diagnosis of “epidermal cyst of the right temporal and superciliary region”, the patient was hospitalized in the Department of ENT + CLS of the Regional Clinical Hospital No. 1 for surgical treatment. On 10/17/2018, the patient underwent surgery: Excision of a neoplasm of soft tissues of the right temporal and superciliary regions. Macropreparation: large formation (10 cm in diameter) with a dense capsule, contains dermoid masses. The material was sent for histological examination.

3. Stages of surgery and macropreparation

4. Condition of postoperative wounds on the 2nd and 5th days after the operation

The postoperative period was uneventful. The wound healed by primary intention (Fig. 4).

On the 6th day, the patient was discharged in a satisfactory condition under the supervision of a dental surgeon at the place of residence. Conclusion of the histopathological examination No. 7451 dated 10/23/2018: fragment of the wall of the epidermal cyst. On the surface of the skin papilloma. Focal perivascular lymphoid infiltrates.

Conclusions

1. Surgical interventions to remove cysts of the soft tissues of the face and neck account for 10.6% of the total number of operations in the maxillofacial region.

2. The pathology is somewhat more common in women (53.8%), most often in young (61.5%) and middle-aged (33.3%) adult patients.

3. The lateral cyst of the neck and epidermoid cysts are more common: 4.1 and 2.7%, respectively, among the entire pathology of the maxillofacial region.

Most of the cysts of the soft tissues of the face have a typical clinical picture and do not present significant difficulties for diagnosis and differential diagnosis. In addition to clinical data, radiation methods (ultrasound, CT) and cytological examination of the punctate of the cyst contents can be used to clarify the diagnosis. The main method of treatment is cystectomy, in most cases a simple operation. However, large cysts may present technical difficulties in performing cystectomy. Timely diagnosis and active motivation of patients for surgical treatment will exclude possible complications and improve the cosmetic outcome of the operation.

Dermoid cyst – the price of treatment in the Primorsky region

• the safest and least traumatic method – SURGITRON
• removal is performed by a doctor with more than 20 years of experience
• no scarring and long-term rehabilitation

removal requires a doctor’s consultation, manipulation – 1000 rub. Its main danger is that it often develops asymptomatically and the patient can find out about the presence of the disease when the cyst suppurates or it degenerates into a malignant volumetric formation. Therefore, it is very important that the treatment of the dermoid cyst is carried out in a timely manner.

Dermoid cyst refers to a variety of fibroepithelial formations with connective tissue walls. The dermoid cyst is usually surrounded by an oval or irregular capsule, and over time can reach the size of a large pea or walnut. The dermoid cyst of the eye can consist of one or several cavities filled with sebaceous mass with an admixture of keratinized skin scales or hair. Depending on the nature of the contents, the cyst may be dense or soft.

Dermoid cysts grow quite slowly, but increase constantly without growth delays.

The reasons for the formation of dermoid cysts have not yet been identified, but it is believed that they mainly occur due to hormonal imbalance or trauma. Most often, degeneration into a malignant tumor occurs when a dermoid cyst is located in the abdominal cavity or in the pelvic area.

Localization of the dermoid cyst can be different

• On the lips
• On the eyelids
• On the nasolabial folds
• On the bridge of the nose
• On the neck
• Near the ears
• On the back of the head

Also dermoid sta can be located on the tissue of the eye, on the abdomen and buttocks, in the anterior mediastinum, in the ovaries. If we talk about an ovarian cyst, then most often a dermoid cyst of the right ovary is detected and it can occur at any age, both in adults and in adolescence and even in childhood.

Clinical picture

A dermoid cyst is usually diagnosed at an early age, as it is a round or elongated “ball” that is located under the skin. When feeling the cyst, pain does not occur in the patient. Diagnosis of a dermoid cyst does not cause difficulties, but in some cases it is necessary to carry out a differential diagnosis. If the cyst is localized in the root of the nose, then it is differentiated from a cerebral hernia. In the case when the dermoid cyst is located on the neck, then it is differentiated from congenital median and lateral cysts. If the cyst is localized in the ovary, then ultrasound is used for diagnosis.

Treatment of a dermoid cyst

The treatment of a dermoid cyst is to remove it. If suppuration of the cyst occurs, then first it is opened, the contents are evacuated, and then the cavity is drained. Removal of the dermoid cyst is performed only after the inflammatory process subsides. The cyst is completely removed within healthy tissues. The operation is performed under local anesthesia and usually lasts no more than 15 minutes. Dermoid cyst in children is removed under general anesthesia.

Thanks to modern techniques, after removal of the cyst, there is no postoperative scarring and the patient can return home on the same day that the operation was performed.