eMedicine Specialties > Dermatology > Pediatric Diseases

Dermoid Cyst

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: Mar 12, 2010

Introduction

Background

The term dermoid cyst does not appear to be restricted to a single kind of lesion nor is it used in only a single medical discipline. The term dermoid cyst can be found in the vocabulary of dermatologists, dermatopathologists, general pathologists, gynecologists, neurosurgeons, or pediatricians. If asked, all of these clinicians would most probably define and describe dermoid cysts differently. For example, gynecologists and general pathologists might say that a dermoid cyst is a cystic tumor of the ovary. In contrast, neurosurgeons tend to view a dermoid cyst is associated with a congenital cyst of the spine or an intracranial congenital cyst. For pediatricians and dermatologists, dermoid cyst means subcutaneous cysts, which are usually congenital.

In all disciplines, however, the common factor is the presence of a solitary, or occasionally multiple, hamartomatous tumor. The tumor is covered by a thick dermislike wall that contains multiple sebaceous glands and almost all skin adnexa. Hairs and large amounts of fatty masses cover poorly to fully differentiated structures derived from the ectoderm.

Depending on the location of the lesion, dermoid cysts may contain substances such as nails and dental, cartilagelike, and bonelike structures. If limited to the skin or subcutaneous tissue, dermoid cysts are thin-walled tumors that contain different amounts of fatty masses; occasionally, they contain horny masses and hairs.

Pathophysiology

Dermoid cysts in the skin and subcutis occur mostly on the face, neck, or scalp.

In addition to the skin, dermoid cysts can be intracranial, intraspinal, or perispinal. Intra-abdominal cysts, such as cystic tumors of the ovary or omentum, occur as well.

Frequency

United States

No information is available about the prevalence of dermoid cysts. In gynecology, the literature describes dermoid cysts as relatively rare tumors, a cystic teratoma that most often occurs in individuals aged 15-40 years. In neurosurgery, dermoid cysts are rare. In dermatology and pediatrics, dermoid cysts are relatively uncommon.

International

The international prevalence is the same as the prevalence in the United States.

Of the 2639 eyelid tumors from a Chinese study, the 5 most common eyelid benign ones were inflammatory lesions, melanocytic nevi, papillomas, dermoid cysts and epidermoid cysts, and epithelial cysts.1

Mortality/Morbidity

Although dermoid cysts are located in connection with the spinal channel (as described in neurosurgery literature), no deaths are directly linked to ruptures of the cyst or to the spreading of fatty and occasionally, infected masses in subarachnoid, ventricular, or subdural compartments. However, rupture or spread can lead to severe neurologic complications such as secondary spinal subdural abscesses.

Race

No racial predilection is apparent; however, most cases of dermoid cysts in the literature are described in white persons.

Sex

  • Dermoid cysts of the ovary are sex restricted, that is, they occur only in the female population.
  • In other dermoid cysts, no sex predilection has been found.

Age

Dermoid cysts have been described in persons of all ages.

  • Dermoid cysts on the face, neck, or scalp are subcutaneous cysts that are usually present at birth. Intracranial or perispinal dermoid cysts are most often found in infants, children, or young adolescents.
  • Intra-abdominal dermoid cysts are described in females aged 15-40 years. For example, cystic teratoma is a relatively rare tumor that most often occurs in females aged 15-40 years.
  • Most dermoid cysts on the floor of the mouth occur in individuals aged 10-30 years. There are few descriptions of oral dermoid cysts in newborns or children.

Clinical

History

  • Dermoid cysts that are congenital and localized on the neck, head, or trunk are usually visible at birth.
  • In some instances, careful medical examination may help to find most dermoid cysts.
  • Intracranial, intraspinal, or intra-abdominal dermoid cysts may be suspected after specific or nonspecific neurologic or gynecologic symptoms occur. In these instances, imaging studies may help in distinguishing dermoid cysts from other tumors or organ malformations (see Imaging Studies). A congenital intracranial frontotemporal dermoid cyst may be first evident as a cutaneous fistula, although intracranial extension and cutaneous sinus tract formation are rarely seen with these dermoid cysts.2
  • Unilateral upper eyelid swelling may be the first sign, with imaging studies demonstrating a soft tissue orbital dermoid cyst arising from the lacrimal gland.3
  • An eyelid dermoid cyst attached to a tarsus may be evident as a firmly adherent nontender upper-eyelid nodule.4
  • Dermoid tumors in the medial canthal area may present as masses adherent to the lacrimal canaliculi.5

Physical

Dermoid cysts can appear as cutaneous cysts on the head, as cysts on the floor of the mouth or elsewhere in the head, within the parotid gland,6 or as cysts in the testes or penis. They can be quite large.7

Specialists in various disciplines may consider dermoid cysts to be different entities.

  • Cutaneous cysts most commonly occur on the head (forehead), mainly around the eyes. Occasionally, they occur on the neck or in a midline region. When on the head, dermoid cysts are often adherent to the periosteum. The usual diameter of the lesions is 1-4 cm.
    • In one study, 25 benign tumors on the forehead and brow of children and adolescents were successfully removed by means of endoscopic excision. Of these, 6 were classified as dermoid cysts. Dermoid cysts on the forehead and brow are known to cause pressure-related erosion of the underlying bony tissue, and surgical intervention may be helpful.
    • In 191 children treated for congenital cysts and fistulas of the neck in 1984-1999, 21 dermoid cysts were found. Periauricular fistulas and cystic hygromas were not included in this study.8
    • Occasionally, skin-related dermoid cysts are multiple and develop over periods as long as 20 years. In one unusual case, multiple subcutaneous dermoid cysts were present in the frontal region of a 41-year-old man, none with evident intracranial extension.
    • In many patients, dermoid cysts occur on the floor of the mouth or elsewhere in the mouth.9,10,11,12
    • Because the term dermoid is frequently used in the literature, some authors believe that this term should be used for all congenital cysts on the floor of the mouth. Three subclasses of congenital mouth cysts are described in the literature: epidermoid (simple) cysts, dermoid (complex) cysts, and teratoid (complex) cysts. Most of these lesions occur in individuals aged 10-30 years. Only a few cases describe dermoid cysts of the mouth in newborns or children.
    • An unusual case of a carcinomatous transformation of a long-standing sublingual dermoid cyst has been described.13
    • Other rare dermoid cysts in the oral cavity are those on the tongue.14,15 As of early 2000, 17 patients with intralingual dermoid cysts are described in the English-language literature. All cases occurred in young patients. Magnetic resonance imaging (MRI) was helpful in establishing the differential diagnosis. Surgical excision corrected deglutition and speech problems in all of these patients.
  • Dermoid cysts can occur elsewhere in the head.
    • Dermoid cysts in the eustachian tube are rare.16 Only 12 patients have been described. In most cases reviewed, cysts affected female patients on the left side. MRI was useful in establishing the correct diagnosis and in selecting the surgical approach.
    • Reports of nasal dermoid cysts were recently published. Of 36 children with nasal dermoid sinus cysts that were treated from 1974-1994, 10 had only a midline cyst, 8 had only nasal pits, and 18 had combined cysts. Meningeal adherences have been found in only 2 patients.17
  • Dermoid cysts can occur in the testes or penis.
    • In a review of cystic testicular lesions in the pediatric population, dermoid cysts were noted.18 Other diagnoses for these cysts include epidermoid cyst, prepubertal teratoma, juvenile granulosa cell tumor, cystic dysplasia of the rete testis, testicular cystic lymphangioma, simple cyst, and cystic degeneration after torsion. An understanding of potentially cystic testicular lesions in children leads to the best treatment choices and often to the preservation of a substantial portion of the affected testis.
    • Dermoid cysts in the penis are extremely rare. Tomasini et al3 described the first in 1997. The patient was a young white male who had significant penile swelling for several months.
    • For neurosurgeons, dermoid cysts are associated with congenital cysts of the spine or intracranial cysts.
    • Several cases involve ruptured cysts and generalized subarachnoid and ventricular spread of the contents (mostly fatty masses).19,20,21
    • In some patients, spinal dermoid cysts, especially those connected to dermal sinus tract, lead to severe neurologic complications such as secondary spinal subdural abscesses caused by the spread of the infection in the dermoid cyst.
  • For gynecologists and general pathologists a dermoid cyst is primarily associated with a cystic tumor of the female ovary.
    • Cystic teratoma is a relatively rare tumor that most often occurs in females aged 15-40 years. A cystic teratoma consists of a thick leatherlike capsule that covers amorphous fatty masses and poorly to fully differentiated structures derived from the ectoderm. Most ovarian dermoid cysts contain skin and skin adnexa, including prominent sebaceous glands, hairs, and nails, but also teeth or eyes. Melanotic changes may also occur. Rare cases of multiple dermoid cysts of the omentum have been reported.22 Dermoid cysts of the ovary are usually benign and easy to remove.
    • Malignant melanomas may originate from melanocytes in ovarian cystic teratomas. Two new cases and 17 older cases in the literature (reported from 1903-1995) are described and were critically reviewed. The present authors found 17 additional cases of benign and malignant melanotic ovarian lesions that were not associated with a dermoid cyst, including 4 melanomas, 3 benign nevi, 5 benign melanosis, and 4 benign and malignant retinal anlage tumors. The extremely rare primary ovarian melanoma was differentiated from the more common melanoma metastatic cyst of the ovary by its unilaterality, the presence of junctional change, and detailed history taking and physical examination, the findings of which excluded other primary sites.23
    • Three patients with metastasizing squamous cell carcinoma from a dermoid cyst of the ovary are described.24 Malignant transformation in a dermoid cyst is a rare complication and mainly occurs in older individuals. Although the prognosis is poor, aggressive therapy may result in long-term remission.

Causes

  • Dermoid cysts are true hamartomas.
  • Dermoid cysts occur when skin and skin structures become trapped during fetal development.
  • Histogenetically, dermoid cysts are a result of the sequestration of skin along the lines of embryonic closure.

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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