Diagnostic Considerations

Neonates often have congenital nodules or sinuses that may require distinction.^[36]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.

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.

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. In fact, a congenital midline dermoid cyst itself, particularly on the frontonasal area, the vertex, or the occipitocervical and low back regions, may represent a cutaneous sign of occult cranial or spinal dysraphism.^[37]

A giant dermoid cyst of the neck can mimic a cystic hygroma, requiring MRI to differentiate.^[38]

A retrorectal (presacral) dermoid cyst has been described in which the lining squamous epithelium showed marked expansion by Paget disease of extramammary type.^[39]

A vascular leiomyoma of the extracranial scalp with a small deformity on the skull in a child may mimic a dermoid cyst.^[40]

A childhood dermoid cyst may mimic a craniopharyngioma.^[41]

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.^[12]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.^[8]

Also consider intramuscular lipoma,^[42]ocular adnexal racemose cysticercosis,^[43]and pilomatrixoma.^[44]

Differential Diagnoses

Workup

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Media Gallery

Dermoid cyst in an unusual location. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/lesions/d-cyst.jpg).

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

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, The Scientific Research Honor Society

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.

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.

Dermoid Cyst Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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