Epidermal cysts L72.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 24.04.2021

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Synonym(s)

Atheroma; Cyst epidermal; Cyst infundibular; epidermal cyst; Epidermal cyst; epidermal cysts; Epidermal cysts; Epidermal cysts traumatic; epidermoidal corneal cyst; Epidermoid cyst; epidermoid cyst (e); Epidermoid cysts; Epithelial cyst; Epithelial cysts; Epithelial cysts traumatic; Follicle cyst; Follicular cysts; Horn cyst; Retention cyst; Retention Cysts; Sebaceous retention cysts; skin cyst; Steatom; Steatoms

Definition
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Frequent, harmless, epithelium-coated cavities of varying size, usually skin-coloured, 1.0 - 3.0 cm, located in the middle or deep dermis, with gelatinous or solid contents, of varying genesis (traumatic, inflammatory, genetic).

Classification
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A distinction is made according to the shutter release:

  • Primary epidermal cyst: Etiologically unexplained.
  • Secondary epidermal cyst: Traumatically induced.

Etiopathogenesis
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In most cases retentions resulting from obstruction of the follicleostium, which secondarily lead to proliferation of the follicular epithelium. Multiple epidermal cysts on the trunk usually occur in connection with an acne vulgaris or conglobata. The etiology of the so-called primary epidermal cysts is unclear.

Manifestation
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Teenagers, young and middle-aged adults,

Localization
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Ubiquitous; mainly affects face, trunk, proximal extremity and rarely soles of feet

Clinical features
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  • Solitary or plural, indolent, deeply dermal, easily delimited, 0.2 to 3.0-5.0 cm large, skin-coloured, only rarely pigmented, plumply elastic tumour which slides on the base. Clinically and dermatoscopically a central porus is usually detectable. Rupture and consecutive acute abscess formation(boils) possible.
  • In the case of multiple epidermal cysts, the medical history usually shows acne vulgaris or acne conglobata.
  • Multiple epidermal cysts characterize the so-called sebocystomatosis scroti.
  • Multiple cysts can be a partial symptom of a Gardner syndrome or basal cell nevus syndrome.
  • Multiple epidermal cysts have also been observed in isolated cases after immunosuppressive treatment of organ transplanted patients with Ciclosporin A.

Histology
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The cyst wall consists of layered squamous epithelium with formation of a stratum granulosum. In the lumen there are stratified horny lamellae like onion shells and more or less hairs depending on the age of the cyst. In case of rupture, dense granulomatous infiltrate with giant cells of foreign body type is found in the cyst lumen and in the surrounding area.

Differential diagnosis
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Complication(s)
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Non-inflamed epidermal cysts generally remain asymptomatic. Improper mechanical processing (faulty expression) can lead to severe abscessing inflammation ( boils). Then there is an indication for surgery! Development of basal cell carcinoma or squamous cell carcinoma in epidermal cysts is rare.

Therapy
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Enucleation with entire capsule in LA, if possible without opening the capsule. In case of inflammation, initially symptomatic therapy, after the inflammation has subsided, excision of the entire focus in LA. In the case of multiple epidermal cysts, an attempt can be made with laser marsupialization.

Literature
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  1. Basterzi Y et al (2002) Giant epidermoid cyst on the forefoot. Dermatol Surgery 28: 639-640
  2. Cameron DS et al (2003) Squamous cell carcinoma in an epidermal inclusion cyst: case report. Otolaryngol Head Neck Surgery 129: 141-143
  3. El Alami M et al (2003) Laser marsupialization of epidermal cysts: avoiding linear scars. J Clin Laser Med Surg 21: 161-163
  4. Ghigliotti G et al (2014) Usefulness of dermoscopy for the diagnosis of epidermal cyst: the 'pore' sign. Clin Exp Dermatol 39:649-650

  5. Gupta S et al (2000) Multiple, large, polypoid infundibular (epidermoid) cysts in a cyclosporin-treated renal transplant recipient. Dermatology 201: 78
  6. Ishida M et al (2014) Epidermal cyst of the skin with ossification: report of two cases. Int J Clin Exp Pathol 7:1823-1825
  7. Lee S et al (2003) Detection of human papillomavirus 60 in epidermal cysts of nonpalmoplantar location. At J Dermatopathol 25: 243-247
  8. Morgan MB et al (2001) Carcinoma arising in epidermoid cyst: a case series and aetiological investigation of human papillomavirus. Br J Dermatol 145: 505-506
  9. Shet T, Desai S (2001) Pigmented epidermal cysts. At J Dermatopathol 23: 477-481
  10. Tsuruta D et al (2000) Combined cutaneous hamartoma encompassing benign melanocytic naevus, vellus hair cyst and epidermoid cyst. Clin Exp Dermatol 25: 38-40

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 24.04.2021