Dermoid Cyst Differential Diagnoses

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 06, 2016
 
 

Diagnostic Considerations

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.[31]

A retrorectal (presacral) dermoid cyst has been described in which the lining squamous epithelium showed marked expansion by Paget disease of extramammary type.[32]

A vascular leiomyoma of the extracranial scalp with a small deformity on the skull in a child may mimic a dermoid cyst.[33]

A congenital intracranial frontotemporal dermoid cyst may be first evident as a cutaneous fistula. Intracranial extension and a cutaneous sinus tract are rarely seen with craniofacial dermoid cysts.[9] Failure to recognize and promptly treat these dermoid cysts may lead to a progressive skeletal distortion and/or recurrent infection with a potential for meningitis or cerebral abscess. Congenital lesions of the midline should always be approached with caution. Imaging studies are prudent.

Important, include dermoid cyst in the differential diagnosis of a tarsus-based eyelid nodule, because misdiagnosis may lead to incision and curettage, resulting in spillage of cyst contents and severe inflammation and scarring.[5]

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, 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 Pediatric Dermatology, 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, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

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

Albert C Yan, MD Section Chief, Associate Professor, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine

Albert C Yan, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology, Society for Pediatric Dermatology, American Academy of Pediatrics

Disclosure: Nothing to disclose.

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