Dermoid Cyst Treatment & Management
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
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.
In some patients with dermoid cysts on the forehead and brow, successful excision with endoscopy-assisted surgery have been described. 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. 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.
Frontozygomatic removal through a blepharoplasty incision has been advocated for frontozygomatic dermoid cysts.
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.
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.
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.
Yan J, Li Y, Chen Q, Ye X, Li J. Rare orbital cystic lesions in children. J Craniomaxillofac Surg. 2015 Mar. 43(2):238-43. [Medline].
Xu XL, Li B, Sun XL, Li LQ, Ren RJ, Gao F. [Clinical and pathological analysis of 2639 cases of eyelid tumors]. Zhonghua Yan Ke Za Zhi. 2008 Jan. 44(1):38-41. [Medline].
Kiratli H, Bilgic S, Sahin A, Tezel GG. Dermoid cyst of the lacrimal gland. Orbit. 2005 Jun. 24(2):145-8. [Medline].
Koreen IV, Kahana A, Gausas RE, Potter HD, Lemke BN, Elner VM. Tarsal dermoid cyst: clinical presentation and treatment. Ophthal Plast Reconstr Surg. 2009 Mar-Apr. 25(2):146-7. [Medline].
Gonsalves SR, Lobo GJ, Mendonca N. Dermoid cyst: an unusual location. BMJ Case Rep. 2013 Nov 8. 2013:[Medline].
Maurice SM, Burstein FD. Disappearing dermoid: fact or fiction?. J Craniofac Surg. 2012 Jan. 23(1):e31-3. [Medline].
Scolozzi P, Lombardi T, Jaques B. Congenital intracranial frontotemporal dermoid cyst presenting as a cutaneous fistula. Head Neck. 2005 May. 27(5):429-32. [Medline].
Tas A, Yagiz R, Altaner S, Karasalihoglu AR. Dermoid cyst of the parotid gland: first pediatric case. Int J Pediatr Otorhinolaryngol. 2010 Feb. 74(2):216-7. [Medline].
Kahraman A, Kahveci R. A giant dermoid cyst. Dermatol Surg. 2008 Sep. 34(9):1273-5. [Medline].
Choi HJ, Kim SH, Lee JH. Unusual Presenting Tadpole-Shaped Dermoid Cyst on Eyebrow. J Craniofac Surg. 2016 May. 27 (3):e281-2. [Medline].
Nicollas R, Guelfucci B, Roman S, Triglia JM. Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 2000 Sep 29. 55(2):117-24. [Medline].
Acree T, Abreo F, Smith BR, Bagby J, Heard JS. Diagnosis of dermoid cyst of the floor of the mouth by fine-needle aspiration cytology: a case report. Diagn Cytopathol. 1999 Feb. 20(2):78-81. [Medline].
Bonilla JA, Szeremeta W, Yellon RF, Nazif MM. Teratoid cyst of the floor of the mouth. Int J Pediatr Otorhinolaryngol. 1996 Dec 5. 38(1):71-5. [Medline].
Vargas Fernandez JL, Lorenzo Rojas J, Aneiros Fernandez J, Sainz Quevedo M. [Dermoid cyst of the floor of the mouth]. Acta Otorrinolaringol Esp. 2007 Jan. 58(1):31-3. [Medline].
Zeltser R, Milhem I, Azaz B, Hasson O. Dermoid cysts of floor of the mouth: report of four cases. Am J Otolaryngol. 2000 Jan-Feb. 21(1):55-60. [Medline].
Devine JC, Jones DC. Carcinomatous transformation of a sublingual dermoid cyst. A case report. Int J Oral Maxillofac Surg. 2000 Apr. 29(2):126-7. [Medline].
Miles LP, Naidoo LC, Reddy J. Congenital dermoid cyst of the tongue. J Laryngol Otol. 1997 Dec. 111(12):1179-82. [Medline].
Myssiorek D, Lee J, Wasserman P, Lustrin E. Intralingual dermoid cysts: a report of two new cases. Ear Nose Throat J. 2000 May. 79(5):380-3. [Medline].
Sichel JY, Dano I, Halperin D, Chisin R. Dermoid cyst of the eustachian tube. Int J Pediatr Otorhinolaryngol. 1999 Apr 25. 48(1):77-81. [Medline].
Carroll CM, Gaffney R, McShane D. Congenital nasal dermoids in children. Ir J Med Sci. 1997 Jul-Sep. 166(3):149-51. [Medline].
Min HJ, Hong SC, Kim KS. The Usefulness of Three-Dimensional Reconstruction Computed Tomography in the Nasal Dermoid Cyst. J Craniofac Surg. 2016 May. 27 (3):819-20. [Medline].
Garrett JE, Cartwright PC, Snow BW, Coffin CM. Cystic testicular lesions in the pediatric population. J Urol. 2000 Mar. 163(3):928-36. [Medline].
Calabrò F, Capellini C, Jinkins JR. Rupture of spinal dermoid tumors with spread of fatty droplets in the cerebrospinal fluid pathways. Neuroradiology. 2000 Aug. 42(8):572-9. [Medline].
Carvalho GA, Cervio A, Matthies C, Samii M. Subarachnoid fat dissemination after resection of a cerebellopontine angle dysontogenic cyst: case report and review of the literature. Neurosurgery. 2000 Sep. 47(3):760-3; discussion 763-4. [Medline].
Karabulut N, Oguzkurt L. Tetraventricular hydrocephalus due to ruptured intracranial dermoid cyst. Eur Radiol. 2000. 10(11):1810-1. [Medline].
Mazumdar A, Vaiphei K, Verma GR. Multiple dermoid cysts of omentum. J Postgrad Med. 1997 Apr-Jun. 43(2):41-2. [Medline].
Davis GL. Malignant melanoma arising in mature ovarian cystic teratoma (dermoid cyst). Report of two cases and literature analysis. Int J Gynecol Pathol. 1996 Oct. 15(4):356-62. [Medline].
Ayhan A, Tuncer ZS, Bilgin F, Kucukali T. Squamous cell carcinoma arising in dermoid cyst. Eur J Gynaecol Oncol. 1996. 17(2):144-7. [Medline].
Ro EY, Thomas RM, Isaacson GC. Giant dermoid cyst of the neck can mimic a cystic hygroma: using MRI to differentiate cystic neck lesions. Int J Pediatr Otorhinolaryngol. 2007 Apr. 71(4):653-8. [Medline].
Thway K, Polson A, Pope R, Thomas JM, Fisher C. Extramammary Paget disease in a retrorectal dermoid cyst: report of a unique case. Am J Surg Pathol. 2008 Apr. 32(4):635-9. [Medline].
Arishima H, Takeuchi H, Kitai R, Yamauchi T, Kikuta KI. Vascular Leiomyoma of the Scalp with a Small Deformity on the Skull Mimicking a Dermoid Cyst. Pediatr Dermatol. 2012 Feb 22. [Medline].
Gleizal A, Abouchebel N, Lebreton F, Beziat JL. Dermoid cyst of the tongue: an association of dermoid cyst with bronchogenic epithelium. J Craniomaxillofac Surg. 2006 Mar. 34(2):113-6. [Medline].
Fernandez-Miranda JC, Engh JA, Pathak SK, et al. High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery. J Neurosurg. 2009 Nov 27. [Medline].
Lin SD, Lee SS, Chang KP, Lin TM, Lu DK, Tsai CC. Endoscopic excision of benign tumors in the forehead and brow. Ann Plast Surg. 2001 Jan. 46(1):1-4. [Medline].
Cozzi DA, Mele E, d'Ambrosio G, Totonelli G, Frediani S, Spagnol L. The eyelid crease approach to angular dermoid cysts in pediatric general surgery. J Pediatr Surg. 2008 Aug. 43(8):1502-6. [Medline].
Agrawal V, Acharya H, Agarwal P, Sekhon V, Sharma D. Subcutaneoscopic excision of external angular dermoid cyst in children without conspicuous scarring. Asian J Endosc Surg. 2013 Aug. 6(3):241-4. [Medline].
Nelson KE, Mishra A, Duncan C. Upper blepharoplasty approach to frontozygomatic dermoid cysts. J Craniofac Surg. 2011 Nov. 22(6):e41-4. [Medline].
Jacquin A, Bejot Y, Hervieu M, et al. [Rupture of intracranial dermoid cyst with disseminated lipid droplets.]. Rev Neurol (Paris). 2009 Oct 19. [Medline].
Tatlidede S, Egemen O, Ozkaya O, Erol O. Witch nose: an embarassing metaphor for nasal tip dermoid cysts. J Craniofac Surg. 2011 Sep. 22(5):1948-51. [Medline].