What are sebaceous cysts and how do they differ from epidermoid cysts. What causes these skin growths to develop. How are epidermoid cysts diagnosed and treated. Can sebaceous cysts go away on their own or require medical intervention.

Understanding Sebaceous and Epidermoid Cysts: What’s the Difference?

When discussing skin growths, the terms “sebaceous cyst” and “epidermoid cyst” are often used interchangeably. However, there’s a crucial distinction between these two types of cysts:

• Sebaceous cysts: These are caused by glands that secrete sebum, an oily substance that lubricates skin and hair.
• Epidermoid cysts: More common than sebaceous cysts, these occur when skin cells accumulate under the skin instead of being shed from its surface.

Understanding this difference is essential for proper diagnosis and treatment. While both types of cysts are generally harmless, they can sometimes cause discomfort or become infected, requiring medical attention.

Identifying Epidermoid Cysts: Key Characteristics and Symptoms

Epidermoid cysts have several distinctive features that can help you identify them:

• Appearance: Dome-shaped bumps under the skin
• Size: Can range from pea-sized to several inches in diameter
• Growth rate: Typically slow-growing
• Texture: Usually movable when touched
• Central punctum: Often have a small black dot through which sebum accumulates

While these cysts are generally painless, they can become problematic under certain circumstances. Is it possible for epidermoid cysts to become inflamed or infected? Yes, in some cases, these cysts can become inflamed, infected, or suddenly rupture, increasing the risk of complications. Signs of infection may include redness, tenderness, warmth, and the excretion of a foul-smelling, cheese-like liquid.

Common Locations for Epidermoid Cysts: Where Do They Typically Appear?

Epidermoid cysts can develop in various areas of the body. The most common locations include:

1. Ears
2. Scalp
3. Face
4. Torso
5. Back
6. Groin area
7. Neck

These cysts may be particularly bothersome when they occur in areas subject to constant irritation, such as on the neck where they rub against a collar or on the back under a bra strap. In such cases, the persistent friction can lead to increased discomfort and a higher likelihood of inflammation.

Causes and Risk Factors: What Contributes to Epidermoid Cyst Formation?

Understanding the underlying causes of epidermoid cysts can help in prevention and management. Several factors contribute to their formation:

• Cell accumulation: When skin cells move deeper into the skin instead of shedding, they can multiply and form cysts.
• Acne: Can contribute to cyst development by damaging or swelling hair follicles.
• Skin injury: Trauma to the skin may sometimes lead to cyst formation.
• Genetic predisposition: Some individuals may be more prone to developing cysts due to genetic factors.

The contents of epidermoid cysts are primarily composed of keratin, a protein secreted by the cells forming the cyst walls. This substance, along with fat and potential infection, contributes to the characteristic odor sometimes associated with these cysts.

The Role of Sebum in Cyst Formation

While epidermoid cysts are not directly caused by sebum production, understanding the role of sebum in skin health is important. Sebum is an oily substance produced by sebaceous glands that helps lubricate and protect the skin. In the case of true sebaceous cysts, an overproduction or blockage of sebum can lead to cyst formation. However, it’s important to note that most cysts referred to as “sebaceous cysts” are actually epidermoid cysts.

Diagnosing Epidermoid Cysts: What to Expect During a Medical Examination

If you suspect you have an epidermoid cyst, seeking medical advice is crucial for proper diagnosis and treatment. Here’s what you can expect during a diagnostic process:

1. Visual examination: Your doctor will typically start with a physical examination of the cyst.
2. Medical history: Be prepared to discuss any recent skin injuries, when you first noticed the cyst, and any family history of cysts.
3. Biopsy: In some cases, a biopsy may be performed to rule out other conditions.
4. Referral: After initial examination by a general practitioner, you may be referred to a dermatologist for specialized care.

Is it necessary to have all cysts examined by a doctor? While not all cysts require immediate medical attention, it’s advisable to have any new or changing skin growths evaluated by a healthcare professional to ensure proper diagnosis and rule out more serious conditions.

Treatment Options: Managing and Removing Epidermoid Cysts

The approach to treating epidermoid cysts varies depending on their size, location, and whether they’re causing discomfort or have become infected. Here are some common treatment options:

• Observation: Many cysts don’t require treatment and may disappear on their own.
• Warm compresses: Applying warm, moist compresses can help drain the cyst naturally.
• Steroid injections: For inflamed cysts, steroid injections can help reduce swelling.
• Surgical removal: Infected or problematic cysts may need to be surgically removed.
• Incision and drainage: In some cases, the cyst may be cut and drained to provide relief.

Can epidermoid cysts be treated at home? While some cysts may resolve on their own, it’s important not to attempt to pop or squeeze a cyst like a pimple, as this can lead to infection. Home care should be limited to warm compresses and keeping the area clean.

When to Seek Medical Attention

While many epidermoid cysts are harmless, certain symptoms warrant immediate medical attention:

• Rapid growth or change in size
• Severe pain or discomfort
• Signs of infection (redness, warmth, pus)
• Interference with daily activities
• Cosmetic concerns

Prevention and Long-Term Management of Epidermoid Cysts

While it’s not always possible to prevent epidermoid cysts, certain measures can help reduce their occurrence and manage existing ones:

1. Maintain good skin hygiene to prevent blockage of hair follicles and pores.
2. Avoid picking or squeezing existing cysts to prevent infection and scarring.
3. Use non-comedogenic skincare products to reduce the risk of clogged pores.
4. Manage underlying skin conditions like acne that may contribute to cyst formation.
5. Protect your skin from injuries that could lead to cyst development.

How often should you monitor existing cysts for changes? It’s advisable to regularly check existing cysts for any changes in size, color, or texture. If you notice any significant changes or develop new symptoms, consult with your healthcare provider.

Distinguishing Epidermoid Cysts from Other Skin Conditions

Accurately identifying an epidermoid cyst is crucial for proper treatment. However, these cysts can sometimes be confused with other skin conditions. Here’s how to differentiate them:

• Lipomas: Soft, fatty lumps that grow under the skin but are typically larger and more rubbery than epidermoid cysts.
• Boils: Painful, pus-filled bumps caused by bacterial infections, usually more inflamed than cysts.
• Skin tags: Small, soft skin growths that typically appear in areas where skin rubs against skin or clothing.
• Milia: Tiny white bumps that typically appear on the face, often mistaken for small cysts.

When in doubt about a skin growth, it’s always best to consult a dermatologist for an accurate diagnosis. They can perform a thorough examination and, if necessary, conduct tests to determine the exact nature of the growth.

The Importance of Professional Diagnosis

While most epidermoid cysts are benign, professional diagnosis is crucial to rule out more serious conditions. In rare cases, what appears to be a simple cyst could be a sign of a more severe skin condition or even a type of skin cancer. A healthcare provider can perform the necessary examinations and tests to ensure an accurate diagnosis and appropriate treatment plan.

Living with Epidermoid Cysts: Impact on Quality of Life

For most people, epidermoid cysts are a minor inconvenience. However, in some cases, they can have a more significant impact on quality of life:

• Physical discomfort: Large or strategically located cysts can cause pain or interfere with movement.
• Emotional impact: Visible cysts, particularly on the face or neck, may affect self-esteem and confidence.
• Social concerns: The fear of cyst rupture or noticeable symptoms can lead to social anxiety.
• Clothing restrictions: Cysts in certain areas may limit clothing choices to avoid irritation.

How can you cope with the psychological impact of visible cysts? If cysts are causing emotional distress, consider speaking with a mental health professional. They can provide strategies for coping with the psychological impact and building self-confidence. Additionally, exploring treatment options with a dermatologist can help address both the physical and emotional aspects of living with epidermoid cysts.

Support and Resources

Living with any skin condition can be challenging, but remember that you’re not alone. Consider the following resources for support and information:

• Support groups for individuals with skin conditions
• Online forums where you can connect with others experiencing similar issues
• Educational materials from reputable dermatology associations
• Consultation with a dermatologist for personalized advice and treatment options

By staying informed and seeking appropriate medical care, most people can effectively manage epidermoid cysts and minimize their impact on daily life.

Myths and Misconceptions About Epidermoid Cysts

There are several common myths and misconceptions surrounding epidermoid cysts that can lead to unnecessary worry or inappropriate treatment attempts. Let’s address some of these:

1. Myth: All lumps under the skin are cysts.
   Reality: Many different types of growths can occur under the skin, including lipomas, boils, and tumors. Professional diagnosis is essential.
2. Myth: Squeezing a cyst will make it go away.
   Reality: Attempting to pop or squeeze a cyst can lead to infection and scarring. It’s best to seek professional treatment.
3. Myth: Epidermoid cysts are contagious.
   Reality: These cysts are not contagious and cannot be spread from person to person.
4. Myth: Cysts always require surgical removal.
   Reality: Many cysts can be managed with conservative treatments or may resolve on their own.
5. Myth: Cysts are always painful.
   Reality: Most epidermoid cysts are painless unless they become infected or inflamed.

Understanding these facts can help individuals make informed decisions about their skin health and seek appropriate care when needed.

The Role of Genetics in Cyst Formation

While not all cases of epidermoid cysts have a genetic component, some individuals may be more prone to developing these cysts due to inherited factors. Certain genetic conditions, such as Gardner syndrome, can increase the likelihood of developing multiple epidermoid cysts. If you have a family history of frequent cyst formation, it’s worth discussing this with your healthcare provider to determine if genetic factors may be playing a role in your case.

Future Developments in Epidermoid Cyst Treatment

As medical research continues to advance, new treatments for epidermoid cysts may become available. Some areas of ongoing research and potential future developments include:

• Minimally invasive removal techniques: Researchers are exploring less invasive methods for removing cysts, potentially reducing scarring and recovery time.
• Topical treatments: New topical medications may be developed to help shrink or eliminate cysts without the need for surgical intervention.
• Targeted therapies: As we learn more about the cellular mechanisms behind cyst formation, targeted therapies may be developed to prevent or treat cysts more effectively.
• Improved diagnostic tools: Advanced imaging techniques may allow for more accurate diagnosis and monitoring of cysts.

While these developments are promising, it’s important to remember that current treatment options are generally effective for managing epidermoid cysts. Always consult with a healthcare professional for the most up-to-date and appropriate treatment options for your specific situation.

The Importance of Ongoing Research

Continued research into epidermoid cysts and other skin conditions is crucial for improving our understanding and treatment of these common issues. Participating in clinical trials, when available, can be a way to contribute to this important work while potentially gaining access to new treatments. If you’re interested in participating in research, discuss this possibility with your dermatologist or check reputable clinical trial registries for opportunities in your area.

In conclusion, while epidermoid cysts can be a nuisance, they are generally harmless and manageable with proper care and treatment. By understanding the nature of these cysts, recognizing when to seek medical attention, and staying informed about treatment options, individuals can effectively manage this common skin condition. Remember, when in doubt, always consult with a healthcare professional for personalized advice and care.

What Is an Epidermoid Cyst (Sebaceous Cyst)? Symptoms, Causes, Diagnosis, Treatment, and Prevention

It’s easy to panic when you notice a lump on your skin. You may wonder if it’s melanoma or another type of skin cancer.

But sebaceous cysts — slow-growing bumps under the skin that can appear on the ears, scalp, face, torso, back, or groin area — are typically harmless. And while they can be irritating (or unsightly), they are not cancerous. Here’s what you need to know — and do — if you have a sebaceous cyst.

The first thing to know is that the term “sebaceous cyst” is often used to describe what is actually an epidermoid cyst. The terms are used interchangeably, but there’s a difference, notes the Cleveland Clinic.

True sebaceous cysts are caused by the glands that secrete the oily matter (sebum) that helps lubricate your skin and the hair, per the Mayo Clinic.

They are not as common as epidermoid cysts, which occur when skin cells accrue under the skin instead of being shed from its surface. This article will mainly focus on epidermoid cysts.

Signs and Symptoms of an Epidermoid Cyst

These dome-shaped cysts can be pea-sized, or grow to a few inches or larger. They grow very slowly, and they’re not painful. If you touch them, you should be able to move them around. They often have a central small black dot, or punctum, through which sebum accumulates.

Sometimes, however, they can become inflamed, infected, or suddenly rupture, which can increase the risk of infection (more on that later). Occasionally, they occur on a site that is constantly irritated, such as a cyst on your neck that rubs against your collar, or one on your back under a bra strap.

Whatever the cause, if you notice redness, tenderness or warmth, that can indicate that the cyst has become infected. You may also notice that the cyst excretes a cheese-like liquid that has a foul smell.

Unpleasant as that may seem, cysts can disappear on their own without treatment, according to Harvard Health.

But if a cyst is bothering you, or becomes painful, it makes sense to see your doctor.

Common Questions & Answers

What is the cause of sebaceous cysts?

Usually when people use the term sebaceous cyst, they’re actually referring to epidermoid cysts. These occur when skin cells accrue under the skin. Sebaceous cysts, which are less common, are caused by the glands that help lubricate skin and hair.

What is a sebaceous cyst filled with?

Sebaceous cysts are filled with sebum, which is the liquid that helps lubricate skin and hair. Epidermal cysts contain dead skin cells that did not get shed from the skin’s surface.

Can you squeeze out a sebaceous cyst?

Do not pop or squeeze the cyst like a pimple. A ruptured cyst could lead to infection. Instead try applying a warm moist compress, which may help the cyst drain.

Do sebaceous cysts go away on their own?

Some sebaceous cysts go away on their own, but, as with epidermal cysts, which don’t tend to go away on their own, they’ll need to be removed if they become infected.

How do you get rid of a sebaceous cyst?

If a sebaceous or epidermal cyst doesn’t cause problems, you probably don’t need any treatment. If a cyst becomes inflamed, it can be injected with a steroid to reduce swelling. Cysts that become infected may need to be surgically removed.

Causes and Risk Factors of an Epidermoid Cyst

The surface of your skin, known as the epidermis, consists of thin layers of cells that are constantly shedding. Sometimes, though, when the cells move deeper into the skin, instead of shedding, they can multiply, leading to cyst formation.

Acne can contribute to their development, as can damaged or swollen hair follicles.

Sometimes, injury to the skin may cause a sebaceous cyst.

And as for that secretion that can emerge from the cyst? It comes from the cells that form the walls of the cysts. Those cells secrete a protein, known as keratin. These cysts are also made of fat, and it’s often that substance, or infection, that makes the smell, according to American Family Physician.

How Is an Epidermoid Cyst Diagnosed?

Usually, your doctor can diagnose a sebaceous cyst by examining your skin, though sometimes he or she may perform a biopsy to make sure it’s not a symptom of another condition. Before your exam, it’s a good idea to note any recent skin injuries, when you first noticed the cyst, if you’ve had any other cysts, and if you have a family history of cysts. Your general practitioner will usually be the one to examine you, and then after that you may be referred to a dermatologist.

Prognosis of Epidermoid Cysts

Most sebaceous cysts can be ignored, since they are not dangerous. Some go away on their own; others grow slowly, but unless they are bothering you, or get infected, you don’t need to do anything about them.

To rule out cancer, your doctor may send a cyst specimen to be examined under a microscope. These will turn out to be basal cell carcinoma — the most common form of skin cancer — or squamous cell carcinoma in less than 1 percent of cases, notes StatPearls.

RELATED: What Is Pilonidal Cyst?

Treatment and Medication Options for Epidermoid Cysts

If a sebaceous cyst does not cause problems and its appearance doesn’t bother you, you probably don’t need any treatment, as mentioned above.

Medication and Surgical Options

If a cyst becomes inflamed, a doctor can inject it with a steroid to reduce swelling. Cysts that become infected, on the other hand, may need to be surgically removed. Dermatologists and plastic surgeons can perform this procedure. To do this, your doctor will make a small puncture and remove the contents. But cysts frequently return after removal and will ultimately need to be surgically removed again. If a cyst becomes swollen or infected, antibiotics may be called for before surgery. Larger cysts may also need to be removed if they cause hair loss on the scalp, interfere with clothing (for instance, if a piece of clothing routinely rubs the cyst, causes irritation), or if the cyst is in an obvious place, like the face.

In some cases, your doctor may use a laser to remove the cyst. A study published in April 2019 in Archives of Craniofacial Surgery found that this approach works well with smaller cysts, leaves smaller scars, and may be a suitable replacement for surgery in an area of cosmetic concern, such as the face.

After the treatment, be sure to follow your doctor’s instructions for keeping the wound clean once you get home, and ask if you should return for a follow up visit.

Alternative and Complementary Therapies

If a sebaceous cyst becomes swollen or tender, home treatments may also help. One easy thing to try: applying a warm moist compress, which can help the cyst drain. What not to do: Resist the urge to pop or squeeze the cyst, like a pimple. It won’t end well.

Prevention of Epidermoid Cysts

Unfortunately, there’s no known way to prevent them from developing.

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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.

4.18. Neck cysts

Neck cysts are fluid filled tumors located on the front or side of the neck (Fig. 1). They can be single-chamber or multi-chamber.

Fig. 1

The origin of neck cysts is predominantly congenital, due to violations of the embryonic development of the gill slits, the development of the thyroid, parathyroid, thymus glands, and the lymphatic system of the neck. However, there are cysts of an acquired nature (consequences of injuries, diseases of the blood and lymphatic system, manifestations of tumor processes).

The median (thyroglossal) cyst of the neck is the result of an intrauterine disorder in the movement of thyroid tissue to the anterior surface of the neck along the thyroid-lingual duct (thyroglossal tract) (Fig. 2).

Fig. 2

Lateral (brachyogenic) cyst of the neck appears as a result of incorrect formation of the first and second gill slits and arches of the embryo (Fig. 3).

Fig. 3

Dermoid cyst can be located both on the front and on the side of the neck, and is formed from the remnants of embryonic tissue. A distinctive feature of this cyst is that it consists of a connective tissue capsule, inside which there are cells of sweat and sebaceous glands, hair follicles, sometimes hair and even teeth.

Congenital cysts most often first manifest themselves clinically in childhood. However, there are times when they appear before the age of 30. The symptoms of neck cysts are varied and depend on their location, size, degree of pressure on nearby organs, and the presence of complications. The most common complication of cysts is their inflammation and suppuration with the formation of fistulas on the neck and mouth. Fistulas of the neck are complete (with two outlets – in the oral mucosa and on the surface of the skin) and incomplete (they have only one hole in one of the places on the skin or oral cavity). In 25% of cases, cysts of the neck can become malignant, and the lateral cyst of the neck is more prone to malignancy than the median one.

A radical cure for neck cysts is possible only with the help of surgical interventions. During surgical operations, the cyst is removed with its walls, the contents of the cyst, the fistulous tract is excised, and in the case of a median cyst, the body of the hyoid bone is also resected. In some cases, with suppuration of cysts and purulent inflammation of the tissue of the neck, surgical interventions are performed in two stages: first, purulent cavities are opened with their sanitation, and after the elimination of the purulent process, a radical removal of the neck cyst is performed. Sometimes punctures of cysts are performed under the control of an ultrasonic sensor or without it (if the cyst is located close to the skin surface and is easily accessible to contact) with the removal of the contents of the cysts (Fig. 4). However, this method of treatment is not radical and can only be used in cases of a serious condition of the patient, which does not allow radical surgery, or as the first stage of treatment for suppuration of cysts.

Fig. 4

Surgical approaches to neck cysts are varied and depend on their location, size, and presence of complications (Fig. 5).

Fig. 5

SOFT TISSUE CYSTS OF THE MAXILLOFACIAL REGION. A CLINICAL CASE OF A LARGE EPIDERMAL CYST Publishing House “CIRCULATION” – Editorum

According to the literature, 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 possibilities 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, SOKB No. 1 for 2018.

Results of the study and their discussion

In 2018, 78 operations for cystic formations of the face and neck were performed in the Department of ENT + CLS of the SOKB No. 1, which accounted for 10.6% of the total number of surgical interventions in the maxillofacial 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 mass had existed for about 10 years, slowly increased in size, did not hurt, did not inflame, only after reaching a large change, it began to cause inconvenience and aesthetic discomfort to the patient. Previously, she turned 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 showed 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

Fig. 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 epidermal cyst wall. 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.