What are dermoid cysts. How are dermoid cysts diagnosed. What are the treatment options for dermoid cysts. How is surgical excision of dermoid cysts performed. What are the potential complications of dermoid cyst surgery. How long is the recovery period after dermoid cyst removal. What is the prognosis for patients who undergo dermoid cyst excision.

Understanding Dermoid Cysts: Types, Locations, and Clinical Presentation

Dermoid cysts are benign tumors that develop from embryonic germ cells. These congenital lesions can occur in various locations throughout the body, including the head and neck region, ovaries, and even within the central nervous system. The cysts are typically lined with skin and may contain hair follicles, sweat glands, and sebaceous glands.

Different types of dermoid cysts include:

• Orbital dermoid cysts
• Nasal dermoid cysts
• Intracranial dermoid cysts
• Ovarian dermoid cysts
• Spinal dermoid cysts

Are dermoid cysts common in children? Dermoid cysts are relatively rare in the pediatric population, but they can occur. When present in children, they are often found in the head and neck region, particularly around the eyes and nose.

Clinical Presentation of Dermoid Cysts

The clinical presentation of dermoid cysts varies depending on their location and size. Common symptoms include:

• A painless, slow-growing mass
• Visible swelling or lump
• Pressure-related symptoms (e.g., visual disturbances for orbital cysts)
• Inflammation or infection if the cyst ruptures

Can dermoid cysts become malignant? While dermoid cysts are typically benign, there have been rare cases of malignant transformation. For example, a case report by Devine and Jones described a carcinomatous transformation of a sublingual dermoid cyst.

Diagnostic Approaches for Dermoid Cysts

Accurate diagnosis of dermoid cysts is crucial for proper management. Various imaging modalities and diagnostic techniques are employed to confirm the presence and characteristics of these lesions.

Imaging Techniques for Dermoid Cyst Diagnosis

What imaging methods are used to diagnose dermoid cysts? Several imaging techniques can be utilized, including:

1. Computed Tomography (CT): CT scans provide detailed cross-sectional images of the affected area. Min et al. highlighted the usefulness of three-dimensional reconstruction CT in nasal dermoid cysts.
2. Magnetic Resonance Imaging (MRI): MRI offers excellent soft tissue contrast and is particularly useful for evaluating intracranial and spinal dermoid cysts.
3. Ultrasound: Tokarz et al. proposed an ultrasound algorithm to differentiate thyroglossal duct and dermoid cysts, demonstrating the value of this non-invasive imaging technique.

Is biopsy necessary for diagnosing dermoid cysts? In some cases, fine-needle aspiration cytology (FNAC) may be performed to confirm the diagnosis. Acree et al. reported a case where FNAC was used to diagnose a dermoid cyst in the floor of the mouth.

Surgical Management of Dermoid Cysts: Techniques and Considerations

Surgical excision is the primary treatment for symptomatic dermoid cysts or those at risk of complications. The specific surgical approach depends on the cyst’s location, size, and relationship to surrounding structures.

Surgical Techniques for Dermoid Cyst Excision

How are dermoid cysts surgically removed? The following techniques may be employed:

• Complete excision: This involves removing the entire cyst, including its capsule, to prevent recurrence.
• Minimally invasive approaches: For certain locations, endoscopic or laparoscopic techniques may be used to minimize scarring and improve recovery time.
• Multi-stage procedures: Complex cases, such as intracranial dermoid cysts, may require staged surgeries to ensure complete removal while minimizing risks.

What precautions are taken during dermoid cyst surgery? Surgeons must exercise caution to avoid rupturing the cyst during excision, as spillage of cyst contents can lead to inflammation and potential recurrence. In cases of large cysts, controlled aspiration may be performed before removal to facilitate extraction.

Potential Complications and Risks Associated with Dermoid Cyst Excision

While dermoid cyst excision is generally safe, it is important to be aware of potential complications that may arise during or after the procedure.

Intraoperative and Postoperative Complications

What are the risks of dermoid cyst surgery? Potential complications include:

• Bleeding and hematoma formation
• Infection
• Nerve injury (depending on the cyst’s location)
• Cyst rupture and spillage
• Incomplete excision leading to recurrence
• Scarring and cosmetic concerns

Can dermoid cyst rupture cause serious problems? In some cases, particularly with intracranial or spinal dermoid cysts, rupture can lead to severe complications. Calabrò et al. reported cases of ruptured spinal dermoid tumors causing dissemination of fatty droplets in the cerebrospinal fluid pathways.

Postoperative Care and Recovery After Dermoid Cyst Excision

Proper postoperative care is essential for optimal healing and minimizing complications following dermoid cyst excision.

Recovery Timeline and Follow-up Care

How long does it take to recover from dermoid cyst surgery? The recovery period varies depending on the cyst’s location and the extent of the surgery. Generally, patients can expect:

• Initial healing: 1-2 weeks for superficial cysts, longer for deep or complex cases
• Return to normal activities: 2-4 weeks, with restrictions on strenuous activities
• Complete healing: 4-6 weeks or longer for extensive surgeries

What follow-up care is required after dermoid cyst removal? Patients should attend scheduled follow-up appointments for wound checks, suture removal (if applicable), and monitoring for potential recurrence. Long-term follow-up may be recommended, especially for complex cases or those with a higher risk of recurrence.

Special Considerations for Pediatric Dermoid Cyst Excision

Dermoid cyst excision in children requires special considerations due to their developing anatomy and the potential impact on growth and development.

Surgical Approaches for Pediatric Dermoid Cysts

How does dermoid cyst surgery differ in children? Key considerations include:

• Timing of surgery: Balancing the need for intervention with the child’s growth and development
• Anesthesia considerations: Pediatric-specific anesthesia protocols and monitoring
• Minimally invasive techniques: When possible, to minimize scarring and recovery time
• Long-term follow-up: Monitoring for potential impacts on growth and development

Are there any unique challenges in treating pediatric dermoid cysts? Yan et al. discussed rare orbital cystic lesions in children, highlighting the importance of accurate diagnosis and appropriate surgical planning in this population.

Emerging Trends and Future Directions in Dermoid Cyst Management

As medical technology and surgical techniques continue to advance, new approaches to dermoid cyst management are emerging.

Innovative Techniques and Research

What new developments are on the horizon for dermoid cyst treatment? Some areas of interest include:

• Advanced imaging techniques: Improved preoperative planning and intraoperative guidance
• Minimally invasive approaches: Refinement of endoscopic and robotic-assisted techniques
• Tissue engineering: Potential for improved reconstruction after large cyst removal
• Molecular targeting: Research into the genetic basis of dermoid cysts for potential non-surgical interventions

How might these advancements impact patient outcomes? These innovations have the potential to reduce surgical morbidity, improve cosmetic results, and potentially offer non-surgical alternatives for certain cases of dermoid cysts.

Long-term Prognosis and Quality of Life After Dermoid Cyst Excision

Understanding the long-term outcomes and impact on quality of life is crucial for patients considering dermoid cyst excision.

Prognosis and Recurrence Rates

What is the long-term outlook for patients who undergo dermoid cyst excision? Generally, the prognosis is excellent, with most patients experiencing complete resolution of symptoms and a low risk of recurrence when the cyst is completely excised. However, the specific prognosis depends on factors such as:

• Location and size of the cyst
• Completeness of excision
• Presence of any complications
• Patient age and overall health

Do dermoid cysts ever disappear on their own? While spontaneous resolution is rare, Maurice and Burstein discussed the concept of “disappearing dermoid” in their 2012 study, highlighting the need for careful follow-up even in cases where the cyst appears to resolve without intervention.

In conclusion, dermoid cyst excision remains the gold standard treatment for these benign lesions. With proper diagnosis, surgical planning, and postoperative care, patients can expect excellent outcomes and a significant improvement in quality of life. As research continues and new techniques emerge, the management of dermoid cysts will likely become even more refined, offering patients improved options for treatment and recovery.

Dermoid Cyst Treatment & Management: Surgical Care

1. Yan J, Li Y, Chen Q, Ye X, Li J. Rare orbital cystic lesions in children. J Craniomaxillofac Surg. 2015 Mar. 43(2):238-43. [QxMD MEDLINE Link].

2. Min HJ, Hong SC, Kim KS. The Usefulness of Three-Dimensional Reconstruction Computed Tomography in the Nasal Dermoid Cyst. J Craniofac Surg. 2016 May. 27 (3):819-20. [QxMD MEDLINE Link].

3. Tokarz E, Gupta P, McGrath J, Szymanowski AR, Behar J, Behar P. Proposed ultrasound algorithm to differentiate thyroglossal duct and dermoid cysts. Int J Pediatr Otorhinolaryngol. 2021 Jan 12. 142:110624. [QxMD MEDLINE Link].

4. Xu XL, Li B, Sun XL, Li LQ, Ren RJ, Gao F. [Clinical and pathological analysis of 2639 cases of eyelid tumors]. Zhonghua Yan Ke Za Zhi. 2008 Jan. 44(1):38-41. [QxMD MEDLINE Link].

5. Madke B, Nayak C, Giri A, Jain M. Nasal dermoid sinus cyst in a young female. Indian Dermatol Online J. 2013 Oct. 4(4):380-1. [QxMD MEDLINE Link]. [Full Text].

6. Kiratli H, Bilgic S, Sahin A, Tezel GG. Dermoid cyst of the lacrimal gland. Orbit. 2005 Jun. 24(2):145-8. [QxMD MEDLINE Link].

7. Bansal R, Honavar SG, Talloju SS, Mulay K. Orbital dermoid cyst. Indian J Ophthalmol. 2022 Feb. 70 (2):709. [QxMD MEDLINE Link]. [Full Text].

8. Koreen IV, Kahana A, Gausas RE, Potter HD, Lemke BN, Elner VM. Tarsal dermoid cyst: clinical presentation and treatment. Ophthal Plast Reconstr Surg. 2009 Mar-Apr. 25(2):146-7. [QxMD MEDLINE Link].

9. Gonsalves SR, Lobo GJ, Mendonca N. Dermoid cyst: an unusual location. BMJ Case Rep. 2013 Nov 8. 2013:[QxMD MEDLINE Link].

10. Kim NJ, Choung HK, Khwarg SI. Management of dermoid tumor in the medial canthal area. Korean J Ophthalmol. 2009 Sep. 23(3):204-6. [QxMD MEDLINE Link]. [Full Text].

11. Maurice SM, Burstein FD. Disappearing dermoid: fact or fiction?. J Craniofac Surg. 2012 Jan. 23(1):e31-3. [QxMD MEDLINE Link].

12. Scolozzi P, Lombardi T, Jaques B. Congenital intracranial frontotemporal dermoid cyst presenting as a cutaneous fistula. Head Neck. 2005 May. 27(5):429-32. [QxMD MEDLINE Link].

13. Tas A, Yagiz R, Altaner S, Karasalihoglu AR. Dermoid cyst of the parotid gland: first pediatric case. Int J Pediatr Otorhinolaryngol. 2010 Feb. 74(2):216-7. [QxMD MEDLINE Link].

14. Kahraman A, Kahveci R. A giant dermoid cyst. Dermatol Surg. 2008 Sep. 34(9):1273-5. [QxMD MEDLINE Link].

15. Choi HJ, Kim SH, Lee JH. Unusual Presenting Tadpole-Shaped Dermoid Cyst on Eyebrow. J Craniofac Surg. 2016 May. 27 (3):e281-2. [QxMD MEDLINE Link].

16. Nicollas R, Guelfucci B, Roman S, Triglia JM. Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 2000 Sep 29. 55(2):117-24. [QxMD MEDLINE Link].

17. Acree T, Abreo F, Smith BR, Bagby J, Heard JS. Diagnosis of dermoid cyst of the floor of the mouth by fine-needle aspiration cytology: a case report. Diagn Cytopathol. 1999 Feb. 20(2):78-81. [QxMD MEDLINE Link].

18. Bonilla JA, Szeremeta W, Yellon RF, Nazif MM. Teratoid cyst of the floor of the mouth. Int J Pediatr Otorhinolaryngol. 1996 Dec 5. 38(1):71-5. [QxMD MEDLINE Link].

19. Vargas Fernandez JL, Lorenzo Rojas J, Aneiros Fernandez J, Sainz Quevedo M. [Dermoid cyst of the floor of the mouth]. Acta Otorrinolaringol Esp. 2007 Jan. 58(1):31-3. [QxMD MEDLINE Link].

20. Zeltser R, Milhem I, Azaz B, Hasson O. Dermoid cysts of floor of the mouth: report of four cases. Am J Otolaryngol. 2000 Jan-Feb. 21(1):55-60. [QxMD MEDLINE Link].

21. Devine JC, Jones DC. Carcinomatous transformation of a sublingual dermoid cyst. A case report. Int J Oral Maxillofac Surg. 2000 Apr. 29(2):126-7. [QxMD MEDLINE Link].

22. Miles LP, Naidoo LC, Reddy J. Congenital dermoid cyst of the tongue. J Laryngol Otol. 1997 Dec. 111(12):1179-82. [QxMD MEDLINE Link].

23. Myssiorek D, Lee J, Wasserman P, Lustrin E. Intralingual dermoid cysts: a report of two new cases. Ear Nose Throat J. 2000 May. 79(5):380-3. [QxMD MEDLINE Link].

24. Sichel JY, Dano I, Halperin D, Chisin R. Dermoid cyst of the eustachian tube. Int J Pediatr Otorhinolaryngol. 1999 Apr 25. 48(1):77-81. [QxMD MEDLINE Link].

25. Carroll CM, Gaffney R, McShane D. Congenital nasal dermoids in children. Ir J Med Sci. 1997 Jul-Sep. 166(3):149-51. [QxMD MEDLINE Link].

26. Garrett JE, Cartwright PC, Snow BW, Coffin CM. Cystic testicular lesions in the pediatric population. J Urol. 2000 Mar. 163(3):928-36. [QxMD MEDLINE Link].

27. Calabrò F, Capellini C, Jinkins JR. Rupture of spinal dermoid tumors with spread of fatty droplets in the cerebrospinal fluid pathways. Neuroradiology. 2000 Aug. 42(8):572-9. [QxMD MEDLINE Link].

28. Carvalho GA, Cervio A, Matthies C, Samii M. Subarachnoid fat dissemination after resection of a cerebellopontine angle dysontogenic cyst: case report and review of the literature. Neurosurgery. 2000 Sep. 47(3):760-3; discussion 763-4. [QxMD MEDLINE Link].

29. Karabulut N, Oguzkurt L. Tetraventricular hydrocephalus due to ruptured intracranial dermoid cyst. Eur Radiol. 2000. 10(11):1810-1. [QxMD MEDLINE Link].

30. Ray CN, Betteridge BC, Demke JC. Infected Nasal Dermoid Cyst/Sinus Tract Presenting With Bilateral Subperiosteal Supraorbital Abscesses: The Midline Nasal Tuft of Hair, an Overlooked Finding. Ophthal Plast Reconstr Surg. 2018 Jan/Feb. 34 (1):e31-e34. [QxMD MEDLINE Link].

31. Mazumdar A, Vaiphei K, Verma GR. Multiple dermoid cysts of omentum. J Postgrad Med. 1997 Apr-Jun. 43(2):41-2. [QxMD MEDLINE Link].

32. Davis GL. Malignant melanoma arising in mature ovarian cystic teratoma (dermoid cyst). Report of two cases and literature analysis. Int J Gynecol Pathol. 1996 Oct. 15(4):356-62. [QxMD MEDLINE Link].

33. Ayhan A, Tuncer ZS, Bilgin F, Kucukali T. Squamous cell carcinoma arising in dermoid cyst. Eur J Gynaecol Oncol. 1996. 17(2):144-7. [QxMD MEDLINE Link].

34. Jacquin A, Bejot Y, Hervieu M, et al. [Rupture of intracranial dermoid cyst with disseminated lipid droplets.]. Rev Neurol (Paris). 2009 Oct 19. [QxMD MEDLINE Link].

35. webmd.com”>Tatlidede S, Egemen O, Ozkaya O, Erol O. Witch nose: an embarassing metaphor for nasal tip dermoid cysts. J Craniofac Surg. 2011 Sep. 22(5):1948-51. [QxMD MEDLINE Link].

36. Rich BS, Dolgin SE. Clarifying Misleading Lumps and Sinuses in the Newborn. Pediatr Rev. 2020 Jun. 41 (6):276-282. [QxMD MEDLINE Link].

37. Bessis D, Société française de dermatologie pédiatrique. [Cutaneous signs of occult cranial and spinal dysraphism]. Ann Dermatol Venereol. 2020 Sep. 147 (8-9):504-519. [QxMD MEDLINE Link].

38. Ro EY, Thomas RM, Isaacson GC. Giant dermoid cyst of the neck can mimic a cystic hygroma: using MRI to differentiate cystic neck lesions. Int J Pediatr Otorhinolaryngol. 2007 Apr. 71(4):653-8. [QxMD MEDLINE Link].

39. Thway K, Polson A, Pope R, Thomas JM, Fisher C. Extramammary Paget disease in a retrorectal dermoid cyst: report of a unique case. Am J Surg Pathol. 2008 Apr. 32(4):635-9. [QxMD MEDLINE Link].

40. Arishima H, Takeuchi H, Kitai R, Yamauchi T, Kikuta KI. Vascular Leiomyoma of the Scalp with a Small Deformity on the Skull Mimicking a Dermoid Cyst. Pediatr Dermatol. 2012 Feb 22. [QxMD MEDLINE Link].

41. Amelot A, Borha A, Calmon R, Barbet P, Puget S. Child dermoid cyst mimicking a craniopharyngioma: the benefit of MRI T2-weighted diffusion sequence. Childs Nerv Syst. 2018 Feb. 34 (2):359-362. [QxMD MEDLINE Link].

42. Vincent J, Baker P, Grischkan J, Fernandez Faith E. Subcutaneous Midline Nasal Mass in an Infant due to an Intramuscular Lipoma. Pediatr Dermatol. 2017 Feb 27. [QxMD MEDLINE Link].

43. webmd.com”>Bothra N, Mittal R, Pradhan A, Tripathy D. Ocular Adnexal Racemose Cysticercosis Masquerading as Dermoid Cyst. Ophthalmic Plast Reconstr Surg. 2019 Mar 12. [QxMD MEDLINE Link].

44. Sirakaya M, Vydianath S. Pilomatrixoma of the head and neck: Typical presentation of a rare lesion. Ultrasound. 2020 Feb. 28 (1):51-53. [QxMD MEDLINE Link].

45. Sharma P, Pathak P, Goyal A, Sharma S. Cytomorphological spectrum of scalp lesions in the population of a developing country: A retrospective study. Diagn Cytopathol. 2019 Feb 13. [QxMD MEDLINE Link].

46. Gleizal A, Abouchebel N, Lebreton F, Beziat JL. Dermoid cyst of the tongue: an association of dermoid cyst with bronchogenic epithelium. J Craniomaxillofac Surg. 2006 Mar. 34(2):113-6. [QxMD MEDLINE Link].

47. webmd.com”>Cao L, Wang Y, Zhao L, Hu X, Cai C. Congenital dermoid inclusion cyst over the anterior fontanel in Chinese children. Clin Dysmorphol. 2020 Apr. 29 (2):81-85. [QxMD MEDLINE Link].

48. Khalid S, Ruge J. Considerations in the management of congenital cranial dermoid cysts. J Neurosurg Pediatr. 2017 Apr 21. 1-5. [QxMD MEDLINE Link].

49. Fernandez-Miranda JC, Engh JA, Pathak SK, et al. High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery. J Neurosurg. 2009 Nov 27. [QxMD MEDLINE Link].

50. Lin SD, Lee SS, Chang KP, Lin TM, Lu DK, Tsai CC. Endoscopic excision of benign tumors in the forehead and brow. Ann Plast Surg. 2001 Jan. 46(1):1-4. [QxMD MEDLINE Link].

51. Cozzi DA, Mele E, d’Ambrosio G, Totonelli G, Frediani S, Spagnol L. The eyelid crease approach to angular dermoid cysts in pediatric general surgery. J Pediatr Surg. 2008 Aug. 43(8):1502-6. [QxMD MEDLINE Link].

52. Agrawal V, Acharya H, Agarwal P, Sekhon V, Sharma D. Subcutaneoscopic excision of external angular dermoid cyst in children without conspicuous scarring. Asian J Endosc Surg. 2013 Aug. 6(3):241-4. [QxMD MEDLINE Link].

53. Nelson KE, Mishra A, Duncan C. Upper blepharoplasty approach to frontozygomatic dermoid cysts. J Craniofac Surg. 2011 Nov. 22(6):e41-4. [QxMD MEDLINE Link].

Dermoid Cyst – StatPearls – NCBI Bookshelf

Continuing Education Activity

A dermoid cyst is a benign cutaneous developmental anomaly that arises from the entrapment of ectodermal elements along the lines of embryonic closure. This activity reviews the evaluation and management of dermoid cysts and highlights the role of the interprofessional team in evaluating and treating patients with this condition.

Objectives:

• Describe the presentation of dermoid cysts.

• Summarize the treatment of dermoid cysts.

• Outline the differential diagnosis of dermoid cysts.

• Review the workup of dermoid cysts and describes the role of health professionals working together to manage this condition.

Access free multiple choice questions on this topic.

Introduction

A dermoid cyst is a benign cutaneous developmental anomaly that arises from the entrapment of ectodermal elements along the lines of embryonic closure.[1][2] These benign tumors are lined by stratified squamous epithelium with mature skin appendages found on their wall and their lumens filled with keratin and hair.[3] Dermoid cysts are considered to be congenital, but not all of them are diagnosed at birth.[3][4][5] Only about 40% of dermoid cysts are diagnosed at birth, while about 60% of the dermoid cysts are diagnosed by five years of age.[3] The dermoid cysts usually present within the first year of life and grow slowly. [1] Dermoid cysts occur most commonly on the head and neck, with 84% of these cysts occurring in this region.[4]

Etiology

The etiology of dermoid cysts remains mostly unknown. The cause of this congenital developmental anomaly has yet to be determined.[3][4] Dermoid cysts are true hamartomas. These occur when skin and skin structures become trapped during fetal development. Prior et al. did not find any correlation between the localization of the dermoid cyst and sex, histology, or age of the patient.[4]

Epidemiology

Dermoid cysts are among the most common pediatric skull tumors.[4][3] Dermoid cysts account for about 15.4%-58.5% of all scalp and skull masses in pediatric patients.[4] Dermoid cysts are usually congenital, with about 70% of cases discovered in children five years old or younger.[3][6] Cases of dermoid cysts discovered in adulthood have also been reported.[3][4] Pollard et al. found a slight predominance of dermoid cysts in girls.[5] However, this significant predominance has not been seen in other case series. [3] No racial predilection is apparent; however, most cases are described in Whites.

Pathophysiology

Dermoid cysts result from an abnormal alteration in fetal development.[2][4] They occur due to the abnormal sequestration and inclusion of the surface ectoderm along the lines of skin fusion during embryologic development.[4][2][7] Due to this abnormality, a dermoid cyst can usually be found along cranial sutures or the anterior fontanelle.[4][2] 

Histopathology

Dermoid cyst on histology shows a well-defined wall lined by stratified squamous epithelium and a lumen that may be filled with mature adnexal structures of mesodermal origin, such as hair follicles and shafts, sebaceous and eccrine glands.[2][4][8]

History and Physical

In the majority of cases, dermoid cysts occur in the head and neck region, although they may be found anywhere on the body.[4][3] In the head and neck region, dermoid cysts can most commonly be seen in the frontal, occipital, and supraorbital areas, with the outer third of the eyebrow being the most frequently affected region. [2][4] An eyelid dermoid cyst attached to a tarsus may present as a firmly adherent non-tender upper eyelid nodule.[9] 

A lower lid dermoid cyst may be evident as a painless, gradually enlarging swelling of the lower lid.[10] Dermoid cysts in the medial canthal area may present as masses adherent to lacrimal canaliculi.[11] 

Dermoid cysts usually occur as solitary lesions; however, multiple concurrent dermoid cysts have also been reported.[2] Dermoid cysts typically present as a pale, flesh-colored, pearly, dome-shaped, firm, deep-seated, subcutaneous nodule.[1][2][3][12] They are usually asymptomatic, non-pulsatile, and non-compressible.[1][2]

Hair protruding from a dermoid cyst punctum is pathognomic for dermoid cysts.[13] Of note, midline dermoid cyst may present as a pit that secreted sebaceous material that can become intermittently inflamed and infected.[3][13]

Evaluation

Dermoid cysts have the potential to grow over time and extend intracranially or intraspinally. [1][3] Due to this potential, one should consider radiological studies before biopsy or manipulation, especially of a lesion that is midline or on the scalp.[3][1] Aspiration or biopsies of dermoid cysts have the potential to cause infection, further leading to osteomyelitis, meningitis, or cerebral abscess.[3][4][14] Other possible complications include bony erosions, eyelid displacement, and intracranial extension.[3][15]

Midline dermoid cysts have the highest association with cranial or spinal dysraphism or have an intracranial extension.[3] Nasal dermoid cysts are the most frequent midline congenital nasal malformations.[3] Studies have shown that there is a 10-45% incidence of intracranial extension in patients with a nasal dermoid cyst.[1] When undergoing neuroimaging, MRI is the preferred means of revealing evidence of intracranial or intraspinal extension.[1][3] Studies showed a higher association between a dermoid cyst located in the frontal and pterional regions and bony erosion. [4][16] If bony erosion is suspected, CT imaging is better at delineating these bony changes.[3][4] In some instances, high-resolution ultrasonography may help reveal a deep component.[3] 

Dermoid cysts under an ultrasound will show a well-defined homogenous and hypoechoic cystic lesion.[2] Fistulography was done preoperatively in some cases to rule out the involvement of a deep tract in a dermoid cyst.[3] Dacryocystography was also performed in some atypical dermoid cysts cases.[3] Furthermore, consultation with a neurosurgeon is highly recommended for dermoid cyst complicated by intracranial or intraspinal extension.[1][3]

Treatment / Management

Dermoid cysts usually tend to grow slowly, further having the potential to cause bony deformities, intracranial extension, or intraspinal extension.[1][4] The presence of intracranial extension or intraspinal extension can further lead to meningitis or develop into an abscess.[1][3] A small, asymptomatic dermoid cyst may not necessitate immediate excision as it can be stable for years or even regress. [3][17] However, because most dermoid cysts grow over time, complete surgical excision without disruption of the cyst wall by an experienced surgeon is recommended before the development of such complications.[3][4]

Early resection may also avoid extensive surgery and a shorter skin incision, further resulting in an improved cosmetic outcome.[3][4] An additional advantage of surgical excision is the possibility of obtaining a histologic diagnosis due to the rare possibility of a malignant tumor presenting as a solitary lump in the head and neck region of a child like a dermoid cyst.[4] The most dermoid cysts can be removed using a direct approach with careful dissection at the site where the cyst adheres to the bone.[3] If the cyst wall ruptures at the time of surgical removal, then remnant tissue should be removed using curettage and copious irrigation.[3]

If the cyst wall has adhered to vital structures, a partial excision may be performed.[3] Recurrences of dermoid cyst have been seen in cases of incomplete excision. [3] Another benefit of early removal of dermoid cysts is a higher chance of obtaining a complete excision without disruption of the cyst wall, a factor associated with a reduced risk of recurrence.[3][4] For small dermoid cysts, endoscopic surgery is a novel approach for removal.[3] In cases of a dermoid cyst with intracranial extension, a craniotomy may still be required.[3]

Differential Diagnosis

Dermoid cysts are rare, but all nodular cystlike lesions are included in the differential diagnoses of a patient presenting with a subcutaneous nodule, especially in the head and neck or midline region.[1][2][3] Following are the differentials of a dermoid cyst:

• Epidermoid cyst

• Glioma

• Encephalocele

• Juvenile xanthogranuloma

• Lipoma

• Pilar cysts

• Meningioma

• Neurofibroma

• Teratoma

• Rhabdomyosarcoma

• Olfactory neuroblastoma

• Lymphoma

• Subcutaneous abscess

• Facial trauma

• Trichilemmal cyst

• Pilomatrixoma

• Lymphatic malformation

• Thyroglossal duct cyst

Prognosis

The overall prognosis for patients with a dermoid cyst is good, especially when there is no intracranial or intraspinal extension. [3] Although histologically benign, dermoid cysts may grow and erode the skull, further being potentially susceptible to the epidural extension.[4] When there is intracranial or, intraspinal extension overall prognosis is still good if there is proper, timely surgical intervention.[3][4] In rare instances, when dermoid cysts become symptomatic due to local mass, effect, rupture, infection, or even in rare cases, cause brain compression prognosis can be poor.[3][4]

Complications

There are no complications for dermoid cysts that don’t have an intracranial or intraspinal extension.[3][4] Dermoid cysts that have intracranial or intraspinal extension may lead to meningitis, abscess, or cause local mass effect.[3][1][4] Aspiration and biopsies of dermoid cysts have the potential to cause infection, further leading to osteomyelitis, meningitis, or cerebral abscess.[1][3]

Other possible complications include bony erosions, eyelid displacement, and intracranial extension.[3] Malignant transformation is a rare complication that may occur in patients with long-standing dermoid cysts. Carcinomatous transformation to squamous cell carcinoma is described in sublingual, ovarian, and intra-abdominal dermoid cysts.

Deterrence and Patient Education

A dermoid cyst is a benign cutaneous developmental anomaly that usually presents in the head and neck regions in pediatric patients.[1] Due to its tendency for growth and possible complications, early surgical intervention is recommended.[3]

Enhancing Healthcare Team Outcomes

An interprofessional team that provides a holistic and integrated approach to diagnosing and treating dermoid cysts can help achieve the best possible outcomes. Health care staff of primary care and emergency departments play a vital role in diagnosing and referring patients with head and neck subcutaneous nodules to dermatology or head and neck surgery. This will aid in better patient satisfaction, quality of life, proper care, and decrease the chance of complications. 

Collaboration shared decision making and communication are crucial elements for a good outcome. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluation of all joint activities. The earlier signs and symptoms of dermoid cysts are identified; the better is the patient outcome, satisfaction, and prognosis.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Dermoid cyst. Contributed by Sunil Munakomi, MD

References

1.

Julapalli MR, Cohen BA, Hollier LH, Metry DW. Congenital, ill-defined, yellowish plaque: the nasal dermoid. Pediatr Dermatol. 2006 Nov-Dec;23(6):556-9. [PubMed: 17155997]

2.

Nakajima K, Korekawa A, Nakano H, Sawamura D. Subcutaneous dermoid cysts on the eyebrow and neck. Pediatr Dermatol. 2019 Nov;36(6):999-1001. [PubMed: 31414508]

3.

Orozco-Covarrubias L, Lara-Carpio R, Saez-De-Ocariz M, Duran-McKinster C, Palacios-Lopez C, Ruiz-Maldonado R. Dermoid cysts: a report of 75 pediatric patients. Pediatr Dermatol. 2013 Nov-Dec;30(6):706-11. [PubMed: 23488469]

4.

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]

5.

Pollard ZF, Calhoun J. Deep orbital dermoid with draining sinus. Am J Ophthalmol. 1975 Feb;79(2):310-3. [PubMed: 1115198]

6.

McAvoy JM, Zuckerbraun L. Dermoid cysts of the head and neck in children. Arch Otolaryngol. 1976 Sep;102(9):529-31. [PubMed: 962697]

7.

Sorenson EP, Powel JE, Rozzelle CJ, Tubbs RS, Loukas M. Scalp dermoids: a review of their anatomy, diagnosis, and treatment. Childs Nerv Syst. 2013 Mar;29(3):375-80. [PubMed: 23180312]

8.

Reissis D, Pfaff MJ, Patel A, Steinbacher DM. Craniofacial dermoid cysts: histological analysis and inter-site comparison. Yale J Biol Med. 2014 Sep;87(3):349-57. [PMC free article: PMC4144289] [PubMed: 25191150]

9.

Koreen IV, Kahana A, Gausas RE, Potter HD, Lemke BN, Elner VM. Tarsal dermoid cyst: clinical presentation and treatment. Ophthalmic Plast Reconstr Surg. 2009 Mar-Apr;25(2):146-7. [PubMed: 19300165]

10.

Gonsalves SR, Lobo GJ, Mendonca N. Dermoid cyst: an unusual location. BMJ Case Rep. 2013 Nov 08;2013 [PMC free article: PMC3830189] [PubMed: 24214152]

11.

Kim NJ, Choung HK, Khwarg SI. Management of dermoid tumor in the medial canthal area. Korean J Ophthalmol. 2009 Sep;23(3):204-6. [PMC free article: PMC2739971] [PubMed: 19794949]

12.

Brownstein MH, Helwig EB. Subcutaneous dermoid cysts. Arch Dermatol. 1973 Feb;107(2):237-9. [PubMed: 4685580]

13.

Wardinsky TD, Pagon RA, Kropp RJ, Hayden PW, Clarren SK. Nasal dermoid sinus cysts: association with intracranial extension and multiple malformations. Cleft Palate Craniofac J. 1991 Jan;28(1):87-95. [PubMed: 2004099]

14.

Yavuzer R, Bier U, Jackson IT. Be careful: it might be a nasal dermoid cyst. Plast Reconstr Surg. 1999 Jun;103(7):2082-3. [PubMed: 10359279]

15.

Pensler JM, Bauer BS, Naidich TP. Craniofacial dermoids. Plast Reconstr Surg. 1988 Dec;82(6):953-8. [PubMed: 3200958]

16.

Pryor SG, Lewis JE, Weaver AL, Orvidas LJ. Pediatric dermoid cysts of the head and neck. Otolaryngol Head Neck Surg. 2005 Jun;132(6):938-42. [PubMed: 15944568]

17.

Shields JA, Shields CL. Orbital cysts of childhood–classification, clinical features, and management. Surv Ophthalmol. 2004 May-Jun;49(3):281-99. [PubMed: 15110666]

Disclosure: Shahjahan Shareef declares no relevant financial relationships with ineligible companies.

Disclosure: Leila Ettefagh declares no relevant financial relationships with ineligible companies.

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Dermoid cyst is currently a very common disease. 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 causes of dermoid cysts have not yet been identified, but it is believed that they mainly occur due to hormonal imbalances or injuries. 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. The dermoid ovarian cyst is removed if it is too large or if there are complications. In girls and young women, the cyst is removed with part of the ovary, and in premenopausal women, the entire ovary is amputated. Laparoscopic surgery may be performed to remove it.

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Ovarian dermoid cyst: causes, symptoms, removal

A dermoid cyst is a tumor that grows in the ovary itself and can only be removed surgically. The med-port.ru clinic, which specializes in laparoscopy in gynecology, offers its patients minimally invasive treatment for this disease.

Ovarian dermoid cyst causes

The reasons for the appearance of dermoid cysts are not exactly established, but it is known that they are laid even before birth. Subsequently, the cyst may appear (acquire visible dimensions), or it may not take shape. A dermoid cyst usually appears in adulthood during a period of hormonal changes: entry into puberty, menopause. The contents of the tumor can be different: fat, cartilage, sebaceous glands, etc. It was the dependence on hormonal changes that caused the appearance of ovarian dermoid cysts to be mainly associated with hormonal factors, although the exact cause of their occurrence is not known.

The presence of a cyst rarely gives any manifestations until it reaches a large size. In this case, the symptoms are standard for a tumor in the internal genital organs: the lower abdomen feels heaviness (regardless of food intake), there may be a violation of urination or defecation if the tumor presses on the corresponding organs.

Dangerous symptoms that threaten the life and health of the patient (acute pain, fever) can occur with inflammation of the cyst and torsion of the legs of the dermoid ovarian cyst. In the latter case, acute inflammation of the peritoneum develops. Obvious signs: a sharp increase in temperature, pain in the lower abdomen. In such cases, you should immediately consult a doctor, urgent hospitalization is necessary.

If a dermoid ovarian cyst was discovered during pregnancy, the decision on further treatment depends on the size of the cyst. If the cyst does not press and does not displace the organs, does not interfere with the normal course of pregnancy, then no action is taken, and treatment is carried out after the birth of the child.

Dermoid ovarian cyst removal

It is impossible to cure this disease conservatively. The dermoid cyst is formed by pathological tissues, therefore it cannot resolve itself. The only way out is surgical treatment. For this, laparoscopic surgery is performed. Laparoscopy is the most common method of surgical interventions in the gynecological field. Such technologies make it possible to carry out organ-preserving treatment (with preservation of ovarian tissue) so that a woman can subsequently become pregnant. Through cosmetic punctures, a video camera and instruments are inserted into the patient’s abdomen. The magnified image is displayed on the screen. The operation to remove the dermoid ovarian cyst is carried out as organ-preserving as possible (with the preservation of ovarian tissue). Also during the operation, samples are taken for histology for the presence of malignant processes. According to statistics, about 1-3% of dermoid cysts tend to become malignant.

Laparoscopy recovery

In the postoperative period after removal of the dermoid ovarian cyst, oral contraceptives are prescribed for 2 months to extinguish ovarian function and allow them to rest.