A dermoid cyst of skin is a cyst which lies deep to the skin and is lined by skin. So a dermoid cyst can be called an epidermal cyst. It contians thin-walled tumors that contain different amounts of fatty masses. Occasionally, they contain horny masses and hairs.
These cysts are lined by squamous epithelium and these contain pultaceous or tooth paste like material which contain desquamated epithelial cells.
There are four types of dermoid cysts
- Sequestration dermoid
- Implantation dermoid-Acquired variety
- Teratomatous dermoid.
This is a congenital variety of dermoid cyst, which is formed by inclusion of epithelium buried at the line of embryonic fusions. So these are found along the lines of fusion of the two embryonic segments.
This cyst is lined by stratified squamous epithelium with hair, hair follicles, sebaceous glands and sweat glands. It contains white pultaceous tooth paste like desquamated material with or without hairs. It is the mixture of sebum, sweat and desquamated epithelial cells.
Common sites are
- At the midline of the body particularly in the neck.
- External angular-just above the outer canthus of the eye-at the line of fusion of the frontonasal and maxillary processes.
- Post auricular-behind the ear at the site of fusion of the mesodermal hillocks.
- On the skull at the site of fusion of the skull bones.
- At the midline of the face particularly at the root of the nose.
At the line of embryonic fusion, a few ectodermal cells are sequestrated into the deeper layer. Ultimately these cells proliferate and liquefy to form a sequestration dermoid cyst. Such cyst lies almost near the mesoderm from where the bones develop, that is why indentation is often found in the underlying bone. Sometimes the cyst starts in the mesoderm so that there may be prolongation of the cyst through the bone and a portion of the cyst may remain intracranial.
The cyst may be noticed at birth, but it is usually seen a few years later-the time taken to form the cyst.
A painless swelling, which is slowly growing is the main symptom. Cosmetic disfigurement is the main complaint. Such cyst hardly becomes big enough to cause any serious mechanical disability and rarely may become infected.
Such cyst hardly attains a size bigger than 2 cm in diameter. It is usually ovoid or spherical in shape and have smooth surface and does not have punctum which is often found in sebaceous cyst.
Cyst feels soft and indents with pressure as the content is thick pultaceous material, mixture of sebum, sweat and desquamated epithelial cells.
The skin can be lifted off the cyst easily. This cyst is also free from underlying structures. There may be bony indentation when the bone lies exactly deep to the cyst.
This may show a depression in the bone underlying the cyst or a gap. Such gap may be present when there is an intracranial extension or a fibrous band may pass through this bony gap and connect the cyst with the underlying durameter.
Complete excision of the cyst is the treatment of choice. This should be done under general anaesthesia as the cyst has to be dissected from the sensitive pericranium moreover there may be intracranial extension.
If preliminary X-ray shows a gap in the underlying bone, the operation has to be delayed to give an opportunity for spontaneous closure.
If there be intracranial extension, osteoplastic flap should be removed for excision of the intracranial part.
It is an acquired dermoid and arises from indriven epithelium beneath the skin due to a puncture injury e.g. needle prick or thorn prick.
Common sites are
- Palm of the hand
It is is quite common in gardeners, tailors and women.
Cyst is usually lined by stratified squamous epithelium with no hair follicle, sweat and sebaceous glands. The content is white cheesy material formed by desquamated epithelial cells and sebium. Hair is usually absent.
A history of puncture injury is usually available. In some cases the patient often forgets of such injury.
A swelling in the finger or the palm is usually the presenting feature. The cyst may be slightly painful.
A tense cystic swelling is found in the finger or the palm. The consistency is often firm or even hard. There may be a scar on the skin overlying the cyst. Fluctuation is very difficult to elicit as the cyst is small and tense.
The most important clinical feature is the presence of a tense cyst in the finger or the palm with a previous history of a punctured wound.
Treatment is complete excision of the cyst.
This is also an epidermal cyst, but such cyst develops from an unobliterated portion of a congenital ectodermal duct or tube.
The cyst is formed by accumulation of secretion of the lining ectodermal cells of the unobliterated portion of an embryonic duct.
- Thyroglossal cyst: develops from the thyroglossal duct. It is the commonest example of tubulo-dermoid cyst.
- Post-anal dermoid: develops from remnant of neurenteric canal or post-anal gut. But it is now regarded as a simple form of teratoma.
- Ependymal cyst is in the brain- from the sequestration of cells derived from the infolding neuroectoderm.
This is a cystic swelling develops from the totipotent cells with ectodermal predominance. Such cyst also contains mesodermal elements like bone, cartilage etc. Hairs are almost always present in such cyst. So the usual contents are bone, cartilage, tooth, hair and cheesy material.
Common sites are
- Ovary-ovarian cyst
- Testis- teratoma
- Mediastinum- mediastinal cyst
- Retroperitoneum- retroperitoneal cyst
- Post- anal dermoid
Complications of Dermoid Cysts
- Pressure symptoms to the surrounding structures