History

Epidermoid cysts are usually asymptomatic. Discharge of a foul-smelling “cheeselike” material may be described. Less frequently, the cysts can become inflamed or infected, resulting in pain and tenderness. In the uncommon event of malignancy, rapid growth, friability, and bleeding may be reported.

Physical Examination

Epidermoid cysts appear as flesh–colored-to-yellowish, firm, round nodules of variable size. A central pore or punctum may be present. Note the image below.

Unusually large epidermoid cyst with a prominent punctum on the back of a patient. (Ruler is in centimeters.)

View Media Gallery

Reportedly, epidermoid cysts are most common (in descending order of frequency) on the face, trunk, neck, extremities, and scalp. Rare cases of epidermoid cysts occurring in bone, breast, and various intracranial locations have been reported.^[36]Epidermoid cysts in the breast and genital area are not uncommon in the general population. The ocular and oral mucosae can also be affected and, cysts have been reported on the palpebral conjunctivae, lips, buccal mucosa, tongue, and uvula.

Epidermoid cysts can manifest in various ways on the extremities. Epidermoid cysts on the distal portions of the digits may extend into the terminal phalanx. These lesions may produce changes in the nails such as pincer nails, erythema, edema, tenderness, and pain.^[37]

Differential Diagnoses

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Media Gallery

Unusually large epidermoid cyst with a prominent punctum on the back of a patient. (Ruler is in centimeters.)
Multiple epidermoid cysts on the forehead of a patient with Gardner syndrome.
Cyst containing keratinous material (hematoxylin and eosin, original magnification X1.6).
Higher-magnification view of the cyst wall of the cyst in Media File 3 demonstrates a true epidermis with a granular layer and adjacent laminated keratinous material (hematoxylin and eosin, original magnification X20).

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Author

Linda J Fromm, MD, MA, FAAD Private Practice, Fromm Dermatology at Health Concepts; Dermatologist, Rapid City Medical Center

Linda J Fromm, MD, MA, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Nathalie C Zeitouni, MDCM, FRCPC Chair of Dermatology, Associate Professor of Dermatology, Roswell Park Cancer Institute

Nathalie C Zeitouni, MDCM, FRCPC is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Women's Dermatologic Society, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

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

Julie C Harper, MD Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham

Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Received honoraria from Stiefel for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Intendis for speaking and teaching; Received honoraria from Coria for speaking and teaching; Received honoraria from Sanofi-Aventis for speaking and teaching.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Kenneth A. Becker, MD, and Isabelle Thomas, MD, to the development and writing of this article.

Epidermal Inclusion Cyst Clinical Presentation

History

Physical Examination

References

Tables

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