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Dermoid Cyst: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Zbigniew Ruszczak, MD, PhD, Consultant Dermatologist and Allergist, Department of Medicine, Division of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, UAE; Consultant in Wound Healing and On-Site-Drug Delivery Systems; Visiting Consultant in Dermatology and Dermatopathology, UMDNJ-New Jersey Medical School, Newark
Contributor Information and Disclosures

Updated: Jul 17, 2009

Differential Diagnoses

Metastatic Carcinoma of the Skin
Metastatic Neoplasms to the Oral Cavity
Pilar Cyst
Pilomatrixoma
Steatocystoma Multiplex

Other Problems to Be Considered

Pilar cysts, also known as trichilemmal cysts, are acquired rather than congenital. They tend to appear on the scalp rather than the face, and they tend to be intradermal rather than subcutaneous.

Although dermoid cysts are rare, they should be included in the differential diagnosis of all nodular cystlike lesions in the head or neck or in a midline (eg, chest midline) in infants and children. An intraoral nodular lesion or tumor of the tongue may be a dermoid cyst.

Cutaneous or lymph node lesions diagnosed as metastases of melanoma or squamous cell carcinoma may reflect other pathologic entities, especially in patients in whom the primary skin tumor could not been identified. Such lesions may represent a late clinical stage in the malignant malformation of melanocytic lesions, or may reflect a malignant squamous epithelial proliferation inside an ovarian dermoid cyst. Although these malignancies are extremely rare, they should be included in the dermatologic differential diagnosis.

The presence of a hair collar sign around a suspected dermoid cyst might indicate cranial dysraphism, such as that seen in a cutaneous ectopic brain.

A giant dermoid cyst of the neck can mimic a cystic hygroma, requiring MRI to differentiate.24

A retrorectal (presacral) dermoid cyst has been described in which the lining squamous epithelium showed marked expansion by Paget disease of extramammary type.25

Workup

Imaging Studies

  • Radiography, CT scanning, and MRI are helpful in making the correct differential diagnosis of dermoid cysts.
  • MRI is particularly helpful in diagnosing intracranial or intramedullary dermoid cysts and in assessing the dissemination of fatty masses or droplets.
  • MRI is helpful in planning surgical procedures and in assessing therapeutic success.
  • Also see the ACR Appropriateness Criteria® suspected adnexal masses.26

Histologic Findings

Dermoid cysts are a result of the sequestration of the skin along the lines of embryonic closure. If connected with the ovary, dermoid cysts are true teratomas.

In contrast to epidermal inclusion cysts, dermoid cysts in the skin are lined by an epidermis that possesses various epidermal appendages. As a rule, these appendages are fully mature. Hair follicles containing hairs that project into the lumen of the cyst are often present. The dermis of dermoid cysts usually contains sebaceous glands, eccrine glands, and, in many patients, apocrine glands. Occasionally, the lining epithelium may proliferate as papillary boundaries extend externally or inward toward the lumen of the cyst. This proliferation may have some superficial resemblance to epidermal carcinomatous proliferation, and the growth may be misclassified as a cancer.

Dermoid cysts in the ovary (cystic teratomas) or those disseminated intra-abdominally may contain other structures such as nails, hairs, or cartilage and bone fragments. These cysts have cell walls that are almost identical to those of the skin, and they may contain multiple adnexal skin structures such as hair follicles, sweat glands, and occasionally, hair, teeth, or nerves.

A congenital dermoid together with a bronchogenic cyst of the tongue is extremely rare but has been described in a few patients.27

More on Dermoid Cyst

Overview: Dermoid Cyst
Differential Diagnoses & Workup: Dermoid Cyst
Treatment & Medication: Dermoid Cyst
Follow-up: Dermoid Cyst
References
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References

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Further Reading

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Zbigniew Ruszczak, MD, PhD, Consultant Dermatologist and Allergist, Department of Medicine, Division of Dermatology, Sheikh Khalifa Medical City, Abu Dhabi, UAE; Consultant in Wound Healing and On-Site-Drug Delivery Systems; Visiting Consultant in Dermatology and Dermatopathology, UMDNJ-New Jersey Medical School, Newark
Zbigniew Ruszczak, MD, PhD is a member of the following medical societies: American Academy of Dermatology, New York Academy of Sciences, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Albert C Yan, MD, Section Chief, Associate Professor, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania
Albert C Yan, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, Society for Investigative Dermatology, and Society for Pediatric Dermatology
Disclosure: Nothing to disclose.

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

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
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.

 
 
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