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Dermoid Cyst Treatment & Management

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

Surgical Care

Surgical excision is the treatment of choice in any localization. Surgically remove dermoid cysts.

In some patients, surgery should be performed even more carefully than usual because the fatty content of the cyst may spread to the surrounding tissues or anatomic structures, especially if the cyst is infected with bacteria. The spread of these contents can cause foreign body reactions and severe complications.

Minimally invasive surgical techniques have been successful in removing dermoid cysts from difficult locations, such as those on the tongue or the floor of the mouth. Intralingual dermoid cysts lead to lingual motility defects and speech problems. These cysts should be surgically removed to restore normal lingual function and to correct speech problems.

Intracranial, intramedullary, and ovarian dermoid cysts are difficult to treat. Sophisticated neurosurgical or gynecologic surgical techniques are often needed to remove the dermoid cyst and prevent possible complications. High-definition fiber tracking guidance may be beneficial in the resection of an intraparenchymal dermoid cyst by means of a minimally invasive endoscopic port.[35]

In some patients with dermoid cysts on the forehead and brow, successful excision with endoscopy-assisted surgery have been described.[36] In the reported cases, no complications (eg, paresthesia or numbness on the scalp) occurred. The absence of visible scarring is an additional advantage of endoscopy-assisted surgery.

Angular dermoid cyst excision using an eyelid crease approach may yield excellent cosmesis.[37] External angular dermoid cysts can be excised using a minimally invasive subcutaneoscopic technique that involves placing incisions above the hairline to avoid scarring on the face.[38]

Frontozygomatic removal through a blepharoplasty incision has been advocated for frontozygomatic dermoid cysts.[39]

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Complications

Several possible complications of spontaneous or posttraumatic rupture and surgical procedures have been described. In patients with a ruptured spinal dermoid cyst, fatty droplets can disseminate in the cerebrospinal fluid or in a dilated central canal of the spinal cord. In other patients, subarachnoid and ventricular fat dissemination can occur after the cerebellopontine angle dermoid cyst is resected. Spinal subdural abscesses are a possible complication because of the bacterial infection of spinal dermoid cysts in a dermal sinus tract. A ruptured intracranial dermoid cyst be an incidental finding on an MRI performed for other purposes or because of a persistent headache.[40]

Pay special attention to intralingual dermoid cysts because deglutition and speech problems may occur.

Nasal dermoid cysts in a nasal tip location are rare, but they may produce social and psychologic problems in children.[41]

Malignant transformation is an unusual complication that may occur in patients with long-standing dermoid cysts. Carcinomatous transformation to a squamous cell carcinoma is described in sublingual and intra-abdominal dermoid cysts, most often dermoid cysts of the ovary. Metastatic malignant melanomas arising from dermoid cysts have been reported in the literature.

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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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