Core Dermatology Diagnoses / CategoriesNeoplastic Benign and Malignant

Dermoid cyst

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Publish date: Posted on
Last updated: May 31, 2022

Keywords #

dermoid cyst
skin nodules

Diagnosis #

Dermoid cysts are 1-4 cm subcutaneous nodules present at birth. They are histologically benign and develop over fusion lines in embryogenesis.[1] Most often, they are solitary lesions that rarely connect to underlying structures, such as the CNS or bone, via sinus tracts. These sinus tracts can drain cerebrospinal fluid if there is a connection to the CNS. Complications of these presentations can include meningitis or bone erosion.[2,3]

Key Concepts #
  • Dermoid cysts are benign congenital lesions.
  • They form when tissue is sequestered during embryonic fusion and can contain hair follicles and glands.[3]
  • Some experts recommend excision to prevent complications, such as bone erosion.
  • Dermoid cysts have the potential to grow slowly over time, increasing the risk for complications.
Epidemiology #

Dermoid cysts account for 15.4%-58.5% of all scalp and skull masses in pediatric patients.[4]

Clinical Features #
  • Slow-growing rubber-like subcutaneous nodules
  • 1-4 cm in diameter
  • Non-pulsatile
  • Non-tender
  • Skin or bluish color
  • Most commonly located on the lateral brow; they can also appear elsewhere on the scalp, face, or along the spine
Differential Diagnoses #
Diagnostic Workup #

Midline dermoid cysts are more likely to harbor deeper connections to the CNS, while those in more lateral locations—such as the lateral brow—are less likely.[6] Thus, MRI or CT imaging should be performed on midline lesions prior to procedures, including excision. [4,7]

Treatment #

Dermoid cysts may not require treatment. However, they can slowly erode the underlying bone, so many experts recommend excision. Those with a connection to the CNS should be removed by Neurosurgery to prevent complications such as meningitis.[7]

References #
  1. Drolet BA. Cutaneous signs of neural tube dysraphism. Pediatr Clin North Am2000; 47:813.
  2. Douvoyiannis M, Goldman DL, Abbott IR 3rd, Litman N. Posterior fossa dermoid cyst with sinus tract and meningitis in a toddler. Pediatr Neurol2008; 39:63.
  3. Brownstein MH, Helwig EB. Subcutaneous dermoid cysts. Arch Dermatol1973; 107:237.
  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.
  5. Shareef S, Ettefagh L. Dermoid Cyst. [Updated 2020 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560573/
  6. J Craniofac Surg. 2012 Sep;23(5):e392-4. doi: 10.1097/SCS.0b013e31825ab1e1.PMID:22976680
  7. Orozco-Covarrubias L, Lara-Carpio R, Saez-De-Ocariz M, Duran-McKinsterC, Palacios-Lopez C, Ruiz-Maldonado R. Dermoid cysts: a report of 75 pediatric patients. Pediatr Dermatol.2013 Nov-Dec;30(6):706-11
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