eMedicine Specialties > Dermatology > Benign Neoplasms

Epidermal Inclusion Cyst: Differential Diagnoses & Workup

Author: Linda J Hanson, MD, MA, Resident Physician, Department of Dermatology, State University of New York at Buffalo School of Medicine
Coauthor(s): Nathalie C Zeitouni, MD, CM, FRCPC, Interim Chair of Dermatology, Chief, Dermatologic Surgery, Associate Professor of Dermatology, Roswell Park Cancer Institute and State University of New York at Buffalo
Contributor Information and Disclosures

Updated: Jun 9, 2009

Differential Diagnoses

Branchial Cleft Cyst
Milia
Calcinosis Cutis
Pachyonychia Congenita
Dermoid Cyst
Pilar Cyst
Gardner Syndrome
Steatocystoma Multiplex
Lipomas

Other Problems to Be Considered

Basal Cell Nevus Syndrome
Nasal glioma
Rheumatoid nodule

Workup

Laboratory Studies

Laboratory studies are typically unnecessary; however, with recurrent infection or lack of response to antibiotics, a culture and sensitivity may be obtained.

Imaging Studies

If an epidermoid cyst is suspected in an unusual location, such as breast, bone, or intracranial locations, imaging with ultrasonography, radiography, CT scanning, or MRI is appropriate.

Other Tests

Fine-needle aspiration has been used to help diagnose epidermoid cysts in unusual locations, such as the breast. Smears of aspirated material stained with Wright-Giemsa stain demonstrate nucleated keratinocytes and wavy keratin material.1

Histologic Findings

Epidermoid cysts are lined with stratified squamous epithelium that contains a granular layer. Laminated keratin contents are noted inside the cyst. An inflammatory response may be present in cysts that have ruptured. Older cysts may exhibit calcification.

Cyst containing keratinous material (hematoxylin ...

Cyst containing keratinous material (hematoxylin and eosin, original magnification X1.6).

[ CLOSE WINDOW ]
Cyst containing keratinous material (hematoxylin ...

Cyst containing keratinous material (hematoxylin and eosin, original magnification X1.6).



Higher-magnification view of the cyst wall of the...

Higher-magnification view of the cyst wall of the cyst in Media File 3 demonstrates a true epidermis with a granular layer and adjacent laminated keratinous material (hematoxylin and eosin, original magnification X20).

[ CLOSE WINDOW ]
Higher-magnification view of the cyst wall of the...

Higher-magnification view of the cyst wall of the cyst in Media File 3 demonstrates a true epidermis with a granular layer and adjacent laminated keratinous material (hematoxylin and eosin, original magnification X20).

More on Epidermal Inclusion Cyst

Overview: Epidermal Inclusion Cyst
Differential Diagnoses & Workup: Epidermal Inclusion Cyst
Treatment & Medication: Epidermal Inclusion Cyst
Follow-up: Epidermal Inclusion Cyst
Multimedia: Epidermal Inclusion Cyst
References
[ CLOSE WINDOW ]

References

  1. Handa U, Kumar S, Mohan H. Aspiration cytology of epidermoid cyst of terminal phalanx. Diagn Cytopathol. Apr 2002;26(4):266-7. [Medline].

  2. Aloi F, Tomasini C, Pippione M. Mycosis fungoides and eruptive epidermoid cysts: a unique response of follicular and eccrine structures. Dermatology. 1993;187(4):273-7. [Medline].

  3. Barr RJ, Headley JL, Jensen JL, Howell JB. Cutaneous keratocysts of nevoid basal cell carcinoma syndrome. J Am Acad Dermatol. Apr 1986;14(4):572-6. [Medline].

  4. Bauer B. Carcinoma arising in a sebaceous cyst. IMJ Ill Med J. Sep 1979;156(3):174-6. [Medline].

  5. Cameron DS, Hilsinger RL Jr. Squamous cell carcinoma in an epidermal inclusion cyst: case report. Otolaryngol Head Neck Surg. Jul 2003;129(1):141-3. [Medline].

  6. Delacretaz J. Keratotic basal-cell carcinoma arising from an epidermoid cyst. J Dermatol Surg Oncol. May-Jun 1977;3(3):310-1. [Medline].

  7. King LA, Barr RJ, Gottschalk HR. Mycosis fungoides with underlying epidermoid cysts. Arch Dermatol. May 1979;115(5):622. [Medline].

  8. Levine DJ, Robertson DB, Varma VA. Familial subconjunctival epithelial cysts associated with the nevoid basal cell carcinoma syndrome. Arch Dermatol. Jan 1987;123(1):23-4. [Medline].

  9. Lopez-Rios F, Rodriguez-Peralto JL, Castano E, Benito A. Squamous cell carcinoma arising in a cutaneous epidermal cyst: case report and literature review. Am J Dermatopathol. Apr 1999;21(2):174-7. [Medline].

  10. Ogata K, Ikeda M, Miyoshi K, et al. Naevoid basal cell carcinoma syndrome with a palmar epidermoid cyst, milia and maxillary cysts. Br J Dermatol. Sep 2001;145(3):508-9. [Medline].

  11. Perse RM, Klappenbach RS, Ragsdale BD. Trabecular (Merkel cell) carcinoma arising in the wall of an epidermal cyst. Am J Dermatopathol. Oct 1987;9(5):423-7. [Medline].

  12. Tanaka M, Terui T, Sasai S, Tagami H. Basal cell carcinoma showing connections with epidermal cysts. J Eur Acad Dermatol Venereol. Sep 2003;17(5):581-2. [Medline].

  13. Swygert KE, Parrish CA, Cashman RE, Lin R, Cockerell CJ. Melanoma in situ involving an epidermal inclusion (infundibular) cyst. Am J Dermatopathol. Dec 2007;29(6):564-5. [Medline].

  14. Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T. Human papillomavirus 57 identified in a plantar epidermoid cyst. Br J Dermatol. Mar 1998;138(3):510-4. [Medline].

  15. Egawa K, Honda Y, Inaba Y, Ono T, De Villiers EM. Detection of human papillomaviruses and eccrine ducts in palmoplantar epidermoid cysts. Br J Dermatol. Apr 1995;132(4):533-42. [Medline].

  16. Egawa K, Honda Y, Inaba Y, Kojo Y, Ono T, de Villiers EM. Multiple plantar epidermoid cysts harboring carcinoembryonic antigen and human papillomavirus DNA sequences. J Am Acad Dermatol. Mar 1994;30(3):494-6. [Medline].

  17. Egawa K, Inaba Y, Ono T, Arao T. 'Cystic papilloma' in humans? Demonstration of human papillomavirus in plantar epidermoid cysts. Arch Dermatol. Dec 1990;126(12):1599-603. [Medline].

  18. Egawa K, Egawa N, Honda Y. Human papillomavirus-associated plantar epidermoid cyst related to epidermoid metaplasia of the eccrine duct epithelium: a combined histological, immunohistochemical, DNA-DNA in situ hybridization and three-dimensional reconstruction analysis. Br J Dermatol. May 2005;152(5):961-7. [Medline].

  19. Kato N, Ueno H. Two cases of plantar epidermal cyst associated with human papillomavirus. Clin Exp Dermatol. Jul 1992;17(4):252-6. [Medline].

  20. Kawase M, Honda M, Niimura M. Detection of human papillomavirus type 60 in plantar cysts and verruca plantaris by the in situ hybridization method using digoxigenin labeled probes. J Dermatol. Oct 1994;21(10):709-15. [Medline].

  21. Kitasato H, Egawa K, Honda Y, Ono T, Mizushima Y, Kawai S. A putative human papillomavirus type 57 new subtype isolated from plantar epidermoid cysts without intracytoplasmic inclusion bodies. J Gen Virol. Aug 1998;79 (Pt 8):1977-81. [Medline].

  22. Lee S, Lee W, Chung S, et al. Detection of human papillomavirus 60 in epidermal cysts of nonpalmoplantar location. Am J Dermatopathol. Jun 2003;25(3):243-7. [Medline].

  23. Morgan MB, Stevens GL, Somach S, Tannenbaum M. Carcinoma arising in epidermoid cyst: a case series and aetiological investigation of human papillomavirus. Br J Dermatol. Sep 2001;145(3):505-6. [Medline].

  24. Park HS, Kim WS, Lee JH, et al. Association of human papillomavirus infection with palmoplantar epidermal cysts in Korean patients. Acta Derm Venereol. 2005;85(5):404-8. [Medline].

  25. Rios-Buceta LM, Fraga-Fernandez J, Fernandez-Herrera J. Human papillomavirus in an epidermoid cyst of the sole in a non-Japanese patient. J Am Acad Dermatol. Aug 1992;27(2 Pt 2):364-6. [Medline].

  26. Shet T, Desai S. Pigmented epidermal cysts. Am J Dermatopathol. Oct 2001;23(5):477-81. [Medline].

  27. Karacal N, Topal U, Kutlu N. Popliteal epidermoid cyst: an unusual location. Plast Reconstr Surg. Sep 1 2004;114(3):830-1. [Medline].

  28. Baran R, Broutart JC. Epidermoid cyst of the thumb presenting as pincer nail. J Am Acad Dermatol. Jul 1988;19(1 Pt 1):143-4. [Medline].

  29. Egawa K, Kitasato H, Ono T. A palmar epidermoid cyst, showing histological features suggestive of eccrine duct origin, developing after a bee-sting. Br J Dermatol. Aug 2000;143(2):469-70. [Medline].

  30. Pandhi R, Gupta S, Kumar B. Multiple epidermoid cysts on photodamaged skin sebaceous gland hyperplasia and senile. J Eur Acad Dermatol Venereol. Mar 2001;15(2):184-5. [Medline].

  31. Bechara FG, Sand M, Rotterdam S, Altmeyer P, Hoffmann K. Multiple epidermal inclusion cysts after axillary liposuction-curettage: a rare complication of a frequent procedure. Int J Dermatol. Nov 2008;47(11):1197-8. [Medline].

  32. Leppard B, Bussey HJ. Epidermoid cysts, polyposis coli and Gardner's syndrome. Br J Surg. May 1975;62(5):387-93. [Medline].

  33. Besser FS. Pachyonychia congenita with epidermal cysts and teeth at birth: 4th generation. Br J Dermatol. Jan 1971;84(1):95-6. [Medline].

  34. Takeshita T, Takeshita H, Irie K. Eruptive vellus hair cyst and epidermoid cyst in a patient with pachyonychia congenita. J Dermatol. Oct 2000;27(10):655-7. [Medline].

  35. Suliman MT. Excision of epidermoid (sebaceous) cyst: description of the operative technique. Plast Reconstr Surg. Dec 2005;116(7):2042-3. [Medline].

  36. Lieblich LM, Geronemus RG, Gibbs RC. Use of a biopsy punch for removal of epithelial cysts. J Dermatol Surg Oncol. Dec 1982;8(12):1059-62. [Medline].

  37. Mehrabi D, Leonhardt JM, Brodell RT. Removal of keratinous and pilar cysts with the punch incision technique: analysis of surgical outcomes. Dermatol Surg. Aug 2002;28(8):673-7. [Medline].

  38. Zuber TJ. Minimal excision technique for epidermoid (sebaceous) cysts. Am Fam Physician. Apr 1 2002;65(7):1409-12, 1417-8, 1420. [Medline].

  39. Yang HJ, Yang KC. A new method for facial epidermoid cyst removal with minimal incision. J Eur Acad Dermatol Venereol. May 3 2009;[Medline].

  40. Aloi FG, Pippione M. Molluscum contagiosum occurring in an epidermoid cyst. J Cutan Pathol. Apr 1985;12(2):163-5. [Medline].

  41. Avakoff JC. Microincision for removing sebaceous cysts. Plast Reconstr Surg. Jul 1989;84(1):173-4. [Medline].

  42. Benharroch D, Sacks MI. Pilomatricoma associated with epidermoid cyst. J Cutan Pathol. Feb 1989;16(1):40-3. [Medline].

  43. Bennett RT, Palmer LS, Kreutzer ER. Massive scrotal epidermal inclusion cysts. Urology. Nov 1996;48(5):781-2. [Medline].

  44. Bhagwandas K, Nicolaou N, Roberts DL. Intraosseous epidermoid cyst mimicking psoriasis. Br J Dermatol. Aug 2001;145(2):366-8. [Medline].

  45. Broekaert D, Goeman L, Ramaekers FC, et al. An investigation of cytokeratin expression in skin epithelial cysts and some uncommon types of cystic tumours using chain-specific antibodies. Arch Dermatol Res. 1990;282(6):383-91. [Medline].

  46. Brook I. Microbiology of infected epidermal cysts. Arch Dermatol. Dec 1989;125(12):1658-61. [Medline].

  47. Chun SI, Im S. An epidermoid cyst with a seborrheic verruca-like cyst wall. J Dermatol. Apr 1990;17(4):260-3. [Medline].

  48. Davies JD, Nonni A, D'Costa HF. Mammary epidermoid inclusion cysts after wide-core needle biopsies. Histopathology. Dec 1997;31(6):549-51. [Medline].

  49. Davies MS, Nicholson AG, Southern S, Moss AH. Squamous cell carcinoma arising in a traumatically induced epidermal cyst. Injury. Mar 1994;25(2):116-7. [Medline].

  50. Dini M, Innocenti A, Romano GF. Basal cell carcinoma arising from epidermoid cyst: a case report. Dermatol Surg. Jun 2001;27(6):585-6. [Medline].

  51. Farrer AK, Forman WM, Boike AM. Epidermal inclusion cysts following minimal incision surgery. J Am Podiatr Med Assoc. Oct 1992;82(10):537-41. [Medline].

  52. Gupta S, Gupta S, Jain VK, Kumar B. A "stone" in the vulva. Sex Transm Infect. Aug 2000;76(4):319. [Medline].

  53. Lee HS, Joo KB, Song HT, et al. Relationship between sonographic and pathologic findings in epidermal inclusion cysts. J Clin Ultrasound. Sep 2001;29(7):374-83. [Medline].

  54. Leppard BJ, Thomson JP, Noble WC. The bacteriology of skin cysts. Br J Dermatol. May 1977;96(5):511-4. [Medline].

  55. Malone JC, Sonnier GB, Hughes AP, Hood AF. Poorly differentiated squamous cell carcinoma arising within an epidermoid cyst. Int J Dermatol. Jul 1999;38(7):556-8. [Medline].

  56. Masessa JM, Schwartz RA, Lambert WC. Bowenoid papulosis in a penile epidermal inclusion cyst. Br J Dermatol. Feb 1987;116(2):237-9. [Medline].

  57. Mehregan DA, al-Sabah HY, Mehregan AH. Basal cell epithelioma arising from epidermoid cyst. J Dermatol Surg Oncol. Jun 1994;20(6):405-6. [Medline].

  58. Oliwiecki S, Ashworth J. Mycosis fungoides with a widespread follicular eruption, comedones and cysts. Br J Dermatol. Jul 1992;127(1):54-6. [Medline].

  59. Papanayotou PH, Kayavis JG. Epidermoid implantation cyst of the lower lip: report of case. J Oral Surg. Jul 1977;35(7):585-6. [Medline].

  60. Park SK, Lee JY, Kim YH, Kim SY, Cho BK, Houh W. Molluscum contagiosum occurring in an epidermal cyst--report of 3 cases. J Dermatol. Feb 1992;19(2):119-21. [Medline].

  61. Silver SGHo VCY. Benign epithelial tumors. In: Freedberg IM, Eisen AZ, Wolff K, et al, eds. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York: McGraw-Hill; 2003:778-779.

  62. Swinehart JM, Golitz LE. Scrotal calcinosis. Dystrophic calcification of epidermoid cysts. Arch Dermatol. Dec 1982;118(12):985-8. [Medline].

  63. Takeshita T, Takeshita H, Irie K. Eruptive vellus hair cyst and epidermoid cyst in a patient with pachyonychia congenita. J Dermatol. Oct 2000;27(10):655-7. [Medline].

  64. Wade CL, Haley JC, Hood AF. The utility of submitting epidermoid cysts for histologic examination. Int J Dermatol. Apr 2000;39(4):314-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

epidermal cyst, epidermoid cyst, epithelial cyst, keratin cyst, sebaceous cyst, milia, basal cell carcinoma, Bowen's disease, SCC, mycosis fungoides, Gardner syndrome, subungual hyperkeratosis, HPV infection, seborrheic keratoses, nevi, subungual epidermoid cyst, terminal phalanx epidermoid cyst, basal cell nevus syndrome, pachyonychia congenita

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Linda J Hanson, MD, MA, Resident Physician, Department of Dermatology, State University of New York at Buffalo School of Medicine
Linda J Hanson, MD, MA is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Nathalie C Zeitouni, MD, CM, FRCPC, Interim Chair of Dermatology, Chief, Dermatologic Surgery, Associate Professor of Dermatology, Roswell Park Cancer Institute and State University of New York at Buffalo
Nathalie C Zeitouni, MD, CM, FRCPC is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Surgery, Dermatology Foundation, International Society for Dermatologic Surgery, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Julie C Harper, MD, Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham
Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Stiefel Honoraria Speaking and teaching; Allergan Honoraria Speaking and teaching; Intendis Honoraria Speaking and teaching; Coria Honoraria Speaking and teaching; Sanofi-Aventis Honoraria Speaking and teaching

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center
Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

RELATED EMEDICINE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.