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Dermoid Cyst
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Last Updated: January 12, 2005
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Synonyms and related keywords: hamartomas, hamartomatous tumor, dermoid cystic tumor,
cystic teratoma, ovarian cystic teratoma, cystic tumor of the ovary, cystic tumors of the omentum,
congenital cyst of the spine, spinal dermoid cysts, subcutaneous cysts, cystic testicular tumor,
intracranial congential cyst, oral dermoid cysts, intracranial dermoid cyst, intraspinal dermoid cyst,
intra-abdominal dermoid cyst
AUTHOR INFORMATION Section 1 of 8
Author Information Introduction Clinical Differentials Workup Treatment Follow-up Bibliography

Author: Zbigniew Ruszczak, MD, PhD

Zbigniew Ruszczak, MD, PhD, is a member of the following medical societies: American Academy
of Dermatology, New York Academy of Sciences, and Sigma Xi
Editor(s): Albert C Yan, MD, Section Chief, Assistant Professor, Department of Pediatrics,
Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania; David
F Butler, MD, Professor, Texas A&M University College of Medicine; Director, Division of
Dermatology, Scott and White Clinic; 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; Glen H Crawford, MD, Assistant
Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine;
Chief, Division of Dermatology, The Pennsylvania Hospital; and Dirk M Elston, MD, Teaching
Faculty, Department of Dermatology, Geisinger Medical Center

Disclosure

INTRODUCTION Section 2 of 8
Author Information Introduction Clinical Differentials Workup Treatment Follow-up Bibliography

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 would
say that a dermoid cyst is associated primarily with a cystic tumor of the ovary. In contrast,
neurosurgeons would say that a dermoid cyst is associated with a congenital cyst of the spine or
an intracranial congential cyst. For pediatricians and dermatologists, dermoid cyst means
subcutaneous cysts, which are usually congenital.

However, in all disciplines, 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:

 In the US: 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.

 Internationally: The international prevalence is the same as the prevalence in the United
States.

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 appears to exist; however, most cases of dermoid cysts in the
literature occurred in whites.

Sex:

 Dermoid cysts of the ovary or omentum 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 are 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. Only
a few cases describe oral dermoid cysts in newborns or children.

CLINICAL Section 3 of 8
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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).

Physical: Dermoid cysts can appear as cutaneous cysts on the head, as cysts on the floor of the
mouth or elsewhere in the head, or as cysts in the testes or penis.

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.

o 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.

o 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.

o Occasionally, skin-related dermoid cysts are multiple and develop over periods as
long as 20 years. In one unusual case, multiple subcutaneous lesions were present
in the frontal region of a 41-year-old man, without intracranial extension. The
lesions were verified as dermoid cysts at histologic examination.

 In many patients, dermoid cysts occur on the floor of the mouth or elsewhere in the
mouth.

o 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.

o An unusual case of a carcinomatous transformation of a long-standing sublingual

dermoid cyst was recently described.

o Other rare dermoid cysts in the oral cavity are those on the tongue. 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.

o Dermoid cysts in the eustachian tube are rare. Only 12 patients with this pathology
are described in the literature. 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.

o 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.
  Dermoid cysts can occur in the testes or penis.

o In a review of cystic testicular lesions in the pediatric population, dermoid cysts

were noted. Other diagnoses for these cysts include epidermoid cyst, prepubertal
teratoma, juvenile granulose 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.

o Dermoid cysts in the penis are extremely rare. Tomasini et al described the first
case of a penile lesion in 1997. The patient was a young white male who had
significant penile swelling for several months. The nodular lesion was
retrospectively determined to be congenital. All laboratory test results were
negative, and excisional biopsy of the lesion in the subcutaneous tissue was
performed. Histologic examination of serial sections revealed a cyst lined by an
epidermoid epithelium and connected with several pilosebaceous units; it was
diagnosed as a dermoid cyst.

 For neurosurgeons, dermoid cysts are associated with congenital cysts of the spine or
intracranial cysts.

o Several cases involve ruptured cysts and generalized subarachnoid and ventricular
spread of the contents (mostly fatty masses).

o 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.

o 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. Dermoid cysts of the ovary are usually benign and easy to
remove.

o 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.
o Three patients with metastasizing squamous cell carcinoma from a dermoid cyst of
the ovary are described. 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.

DIFFERENTIALS Section 4 of 8
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Metastatic Carcinoma of the Skin

Metastatic Neoplasms to the Oral Cavity
Pilar Cyst
Pilomatrixoma
Steatocystoma Multiplex

Other Problems to be Considered:

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.

Skin lesion or lymph node lesions diagnosed as metastases of malignant 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 they 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

WORKUP Section 5 of 8
Author Information Introduction Clinical Differentials Workup Treatment Follow-up Bibliography

Imaging Studies:

 Radiography, CT scanning, and MRI are helpful in making the correct differential
diagnosis of dermoid cysts.

 MRI is particularly helpful in diagnosing intracranial or intramedullary dermoid cysts and in

assessing the dissemination of fatty masses or droplets.

 MRI is helpful in planning surgical procedures and in assessing therapeutic success.

Histologic Findings: Dermoid cysts are a result of the sequestration of the skin along the lines
of embryonic closure. If connected with the ovary, dermoid cysts are true teratomas.

In contrast to epidermal cysts, dermoid cysts in the skin are lined by an epidermis that possesses
various epidermal appendages. As a rule, these appendages are fully mature. Hair follicles
containing hairs that project into the lumen of the cyst are often present. The dermis of dermoid
cysts usually contains sebaceous glands; eccrine glands; and, in many patients, apocrine
glands. Occasionally, the lining epithelium may proliferate as papillary boundaries extend
externally or inward toward the lumen of the cyst. This proliferation may have some superficial
resemblance to epidermal carcinomatous proliferation, and the growth may be misclassified as a
cancer.

Dermoid cysts in the ovary or those disseminated intra-abdominally may contain other structures
such as nails, hairs, or cartilage and bone fragments. The cysts have cell walls that are almost
identical to those of the skin, and they may contain multiple adnexal skin structures such as hair
follicles; sweat glands; and occasionally, hair, teeth, or nerves.

TREATMENT Section 6 of 8
Author Information Introduction Clinical Differentials Workup Treatment Follow-up Bibliography

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.

 Recently, 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, and
sophisticated neurosurgical or gynecologic surgical techniques are often needed to
remove the lesion and prevent possible complications.

 In some patients with dermoid cysts on the forehead and brow, successful excision with
endoscopy-assisted surgery have been described.

o In the reported cases, no complications (eg, paresthesia or numbness on the scalp)

occurred.

o The absence of visible scarring is an additional advantage of endoscopy-assisted

surgery.

FOLLOW-UP Section 7 of 8
Author Information Introduction Clinical Differentials Workup Treatment Follow-up Bibliography

Complications:

 Several possible complications of spontaneous or posttraumatic rupture and surgical

procedures have been described.

o 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.

o In other patients, subarachnoid and ventricular fat dissemination can occur after the
cerebellopontine angle dermoid cyst is resected.

o Spinal subdural abscesses are a possible complication because of the bacterial

infection of spinal dermoid cysts in a dermal sinus tract.

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

 Malignant transformation is an unusual complication that may occur in patients with long-
standing dermoid cysts.
 o Carcinomatous transformation to a squamous cell carcinoma is described in
sublingual and intra-abdominal dermoid cysts, most often dermoid cysts of the
ovary.

o Metastatic malignant melanomas arising from dermoid cysts have been reported in
the literature.

Prognosis:

 If dermoid cysts are diagnosed early and treated with complete surgical excision, the
prognosis is good, and no further complications are expected.

 In patients with carcinomatous transformation, the prognosis depends on the stage of the
malignant disease (locally limited or spreading) and the success of therapy.

Patient Education:

 For excellent patient education resources, visit eMedicine's Procedures Center and
Women's Health Center. Also, see eMedicine's patient education articles Dermoid Cyst
Removal and Ovarian Cysts.

BIBLIOGRAPHY Section 8 of 8
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