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Digital Mucous Cyst

  • Author: Murad Alam, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Mar 20, 2015
 

Background

Digital mucous cysts (DMCs) are benign ganglion cysts of the digits, typically located at the distal interphalangeal (DIP) joints or in the proximal nail fold. They usually occur on the hands, although they have also been noted on the toes. The etiology of these cysts is uncertain but may involve mucoid degeneration. Often, these cysts are asymptomatic and do not require treatment. When treatment is indicated, medical therapies and surgical interventions of varying magnitudes may be attempted. Recurrence is common.

Historically, little attention has been directed at studying these cysts despite their frequency. In the literature, they have been referred to as cystomata, myxomatous cutaneous cysts, myxomatous degenerative cysts, periarticular fibromas, synovial lesions of the skin, periungual ganglions, mucous cysts, myxoid cysts, synovial cysts, dorsal cysts, nail cysts, cystic nodules, digital mucoid cysts, digital myxoid cysts, and digital mucinous pseudocysts.

Hippocrates first appreciated ganglion cysts, describing a knot of tissue full of fluid. In 1746, Eller concluded that ganglia formed from the herniation of the synovial lining of a joint. In 1882, Hyde first described the digital mucous cyst. In 1893, Ledderhose suggested that ganglia arose spontaneously in the subcutaneous tissue. In 1895, Ritschel proposed the earliest formulation of the theory that mucoid degeneration may be responsible for digital mucous cysts; Carp and Stout popularized the theory in 1928. Then, in 1947, Anderson reported that cysts caused the nail deformities.

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Pathophysiology

The mechanism of formation of digital mucous cysts is unknown. Currently, it is believed that the cysts arise from mucoid degeneration of connective tissue and that this process, in most cases, involves communication with the adjacent DIP joint and possible coexistence of osteoarthritis. Clinical and radiographic evidence of osteoarthritis is common at the site of the cysts,[1] and the frequent presence of osteophytes and spurring of the DIP joint were recognized in the 1970s. Active connection to the joint space may or may not exist, as the mucoblasts associated with the cyst appear capable of sustaining the process.

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Epidemiology

Frequency

United States

Ganglia are the most common tumor or cyst of the hand. They account for approximately 70% of all such tumors or cysts, with digital mucous cysts comprising 10-15% of the total.

International

Frequency data are limited but not significantly different from US statistics.

Mortality/Morbidity

Digital mucous cysts most often are asymptomatic and benign. Pain can result from the impingement of cysts on adjacent nerve fibers. Larger cysts can disfigure the affected digit. Nail deformities can occur.

Sex

Women are affected more often than men (female-to-male ratio of 2-2.5:1).

Age

Digital mucous cysts usually occur in the fifth to seventh decades, yet they may be seen as early as the teenage years or among the elderly population. The mean age of onset is 60 years. One report describes a case in association with cutaneous mucinosis of infancy.

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Contributor Information and Disclosures
Author

Murad Alam, MD Professor of Dermatology, Otolaryngology, and Surgery; Chief, Section of Cutaneous and Aesthetic Surgery, Department of Dermatology, Northwestern University; Director, Mohs Micrographic Surgery, Northwestern Memorial Hospital

Murad Alam, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society of Transplantation, Phi Beta Kappa, Society for Investigative Dermatology, American College of Aesthetic and Cosmetic Physicians; American Society of Aesthetic/Cosmetic Physicians, Women's Dermatologic Society, Dermatology Foundation, Illinois Dermatological Society, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Natalie Ann Kim-Orden, MD Intern, Children's Hospital of Los Angeles

Disclosure: Nothing to disclose.

Melanie Warycha, MD Procedural Dermatology Fellow, Department of Dermatology, Northwestern University Feinberg School of Medicine

Melanie Warycha, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Kira Minkis, MD, PhD Director of Mohs and Dermatologic Surgery, Director of Surgical, Laser, and Cosmetic Education, Assistant Professor, Department of Dermatology, Weill Cornell Medical College; Attending Physician, New York Presbyterian Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

David Bickers, MD, Chairman, Carl Truman Nelson Professor, Department of Dermatology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons

Disclosure: Nothing to disclose.

Mary Farley, MD Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

References
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  3. Kivanc-Altunay I, Kumbasar E, Gokdemir G, Koslu A, Tekkesin M, Basak T. Unusual localization of multiple myxoid (mucous) cysts of toes. Dermatol Online J. 2004 Jul 15. 10(1):23. [Medline].

  4. Hur J, Kim YS, Yeo KY, Kim JS, Yu HJ. A case of herpetiform appearance of digital mucous cysts. Ann Dermatol. 2010 May. 22(2):194-5. [Medline]. [Full Text].

  5. Hwang CY, Huang YL, Liu HN. Digital mucous cysts presenting as numerous translucent nodules in the right fifth finger. J Chin Med Assoc. 2011 Feb. 74(2):102-3. [Medline].

  6. Drape JL, Idy-Peretti I, Goettmann S, et al. MR imaging of digital mucoid cysts. Radiology. 1996 Aug. 200(2):531-6. [Medline].

  7. Daffner RH, Whitfield PW. Recurrent ganglion cyst: the value of preoperative ganglionography. AJR Am J Roentgenol. 1977 Aug. 129(2):345-6. [Medline].

  8. Dodd LG, Layfield LJ. Fine-needle aspiration cytology of ganglion cysts. Diagn Cytopathol. 1996 Dec. 15(5):377-81. [Medline].

  9. Epstein E. A simple technique for managing digital mucous cysts. Arch Dermatol. 1979 Nov. 115(11):1315-6. [Medline].

  10. Epstein E. Steroid injection of myxoid finger cysts. JAMA. 1965. 194:98-99.

  11. Bardach HG. Managing digital mucoid cysts by cryosurgery with liquid nitrogen: preliminary report. J Dermatol Surg Oncol. 1983 Jun. 9(6):455-8. [Medline].

  12. Audebert C. Treatment of mucoid cysts of fingers and toes by injection of sclerosant. Dermatol Clin. 1989 Jan. 7(1):179-81. [Medline].

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  14. Huerter CJ, Wheeland RG, Bailin PL, Ratz JL. Treatment of digital myxoid cysts with carbon dioxide laser vaporization. J Dermatol Surg Oncol. 1987 Jul. 13(7):723-7. [Medline].

  15. Kemmett D, Colver GB. Myxoid cysts treated by infra-red coagulation. Clin Exp Dermatol. 1994 Mar. 19(2):118-20. [Medline].

  16. Jamnadas-Khoda B, Agarwal R, Harper R, Page RE. Use of Wolfe Graft for the Treatment of Mucous Cysts. J Hand Surg Eur Vol. 2009 Apr 24. [Medline].

  17. Blume PA, Moore JC, Novicki DC. Digital mucoid cyst excision by using the bilobed flap technique and arthroplastic resection. J Foot Ankle Surg. 2005 Jan-Feb. 44(1):44-8. [Medline].

  18. Imran D, Koukkou C, Bainbridge LC. The rhomboid flap: a simple technique to cover the skin defect produced by excision of a mucous cyst of a digit. J Bone Joint Surg Br. 2003 Aug. 85(6):860-2. [Medline].

  19. Johnson SM, Treon K, Thomas S, Cox QG. A reliable surgical treatment for digital mucous cysts. J Hand Surg Eur Vol. 2013 Oct 25. [Medline].

  20. de Berker D, Lawrence C. Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid. Arch Dermatol. 2001 May. 137(5):607-10. [Medline].

  21. Herndon JH, Myers SR, Akelman E. Advanced surgery. Scher RK, Daniel CR, eds. Nails: Therapy Diagnosis, Surgery. 2nd ed. Philadelphia: WB Saunders Co; 1997. 350-362.

  22. Norton LA. Tumors. Scher RK, Daniel CR, eds. Nails: Therapy, Diagnosis, Surgery. 2nd ed. Philadelphia: WB Saunders Co; 1997. 262-275.

 
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Digital mucous cyst proximal to nail unit.
Digital mucous cyst at proximal nail fold.
Histopathology of digital mucous cyst.
 
 
 
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