ABSTRACT: Epidermoid cysts represent the most common cutaneous cysts. While these may occur anywhere on the body, they occur most frequently on the face, scalp, neck and trunk. A report of four cases and their clinicopathological features are described in this article

Anubha Gulati

Hemant Batra

Renu Yadav

Satya Narain

English

eDENT Journals

Epidermoid Cysts of Face: Clinicopathological 
Presentation and a report of four cases. 
Satya Narain,1 Anubha Gulati,2 Renu Yadav,3 Hemant Batra4 
 
 
 
Introduction   
   
 Epidermoid cyst is intradermal sac-like structure which is lined with squamous 
epithelium containing keratohyaline granules. An epidermal cyst is derived from 
epidermis, and  is formed by cystic enclosure of epithelium within the dermis that 
becomes filled with keratin and  lipid-rich debris [1]. In the past, epidermoid cysts have 
been referred to by various terms including follicular infundibular cysts, epidermal 
cysts and epidermal inclusion cysts. The term epidermal inclusion cyst refers 
specifically to an epidermoid cyst that is the result of the implantation and 
proliferation of epidermal elements in the dermis. Since most of these lesions arise 
from the follicular infundibulum, the more general term epidermoid is more 
appropriate. 
 
Both dermoid and epidermoid cysts are ectoderm-lined  inclusion cysts while 
epidermoid cysts have only squamous epithelium; dermoid cysts contains hair, 
squamous epithelium, sebaceous and sweat glands [1]. Epidermoid cysts are benign 
lesions; however rare cases of various associated malignancies have been reported [2, 
3, 4, 5, 6, 7].  
 
Epidermoid cysts are usually asymptomatic lesions and present as flesh- colored to 
yellowish, firm, round mobile subcutaneous nodules of variable size. Size generally 
varies from 0.5 to 5cm. A central pore or punctum may be present. These lesions may 
become inflamed or secondarily infected, resulting in swelling and tenderness [8]. 
 
Epidermoid cysts are approximately twice as common in men as in women and may 
occur at any age; however they most commonly arise in fourth decade of life. 
 Facial epidermoid cysts are easily diagnosed by clinical examination, no laboratory 
study are necessary and imaging investigations are not required for epidermoid cysts 
on face as these are present very superficially on skin. 
 
Epidermoid cysts are very slowly growing lesions, patient generally do not seek 
consultation when the lesion is asymptomatic. Treatment is surgical excision or 
incision with removal of the cyst and cyst wall through the surgical defect. 
Histologically, epidermoid cysts are lined with stratified squamous epithelium that 
contains a granular layer with central lumen filled with laminated keratin. Calcification 
can be seen in older cysts. 
 
 
   IJCDS • MARCH, 2012 • 3(1) © 2012  Int. Journal of Clinical Dental Science 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ABOUT THE AUTHORS 
1. Dr Satya Narain 
 
Associate Professor, Oral 
And Maxillofacial Surgery, 
Dr H.S. Judge Institute Of 
Dental Sciences And 
Hospital, Panjab University 
Chandigarh. 
 
 
2. Dr Anubha Gulati 
 
Associate Professor, Oral 
Pathology, Dr H.S. Judge 
Institute Of Dental Sciences 
And Hospital, Panjab 
University Chandigarh. 
 
3. Dr Renu Yadav 
 
Associate Professor, Oral 
Pathology, Dr H.S. Judge 
Institute Of Dental Sciences 
And Hospital, Panjab 
University Chandigarh. 
 
4. Dr Hemant Batra 
 
Professor And Incharge, Oral 
and Maxillofacial Surgery, 
Dr H.S. Judge Institute Of 
Dental Sciences And 
Hospital,Panjab University 
Chandigarh. 
 
 
 
 
Corresponding Author:  
 
Dr Satya Narain 
 
Associate Professor, Oral 
And Maxillofacial Surgery, 
Dr H.S. Judge Institute Of 
Dental Sciences And 
Hospital, Panjab University 
Chandigarh. 
 
drsatya.maxfac@hotmail.com 
 
 
 
Abstract      
                         
  Epidermoid cysts represent the most common cutaneous cysts. While these may occur 
anywhere on the body, they occur most frequently on the face, scalp, neck and trunk. A report 
of four cases and their clinicopathological features are described in this article. 
 
KEY WORDS: Epidermoid cysts, epidermal inclusion cyst, face, skin and surgery.  
 
                                                                                                                                                                                      
 
30 
CASE REPORT 
   IJCDS • MARCH, 2012 • 3(1) © 2012  Int. Journal of Clinical Dental Science 
 
Fig. 1a,b Clinical picture of epidermoid cyst attached to tragus of ear 
 
 
 
Fig.2 Surgical specimen of excised epidermoid cyst. 
 
               
   
Figure 3.  Photomicrograph of cyst wall showing 
stratified squamous epithelial lining with the luminal 
surface depicting abundant laminated keratin. (H&E, 
4X) 
 
 
31 
   IJCDS • MARCH, 2012 • 3(1) © 2012  Int. Journal of Clinical Dental Science 
        
 
Fig. 4 Clinical picture showing two small epidermoid 
cysts on skin of forehead, central punctum is also 
seen on both lesions. 
                 . 
                                         
Fig.5. Operative photograph showing enucleation of 
lesion through minimal invasive approach 
                 
 
       Fig.6 Photograph of surgical specimens  
                         
 
Fig.7A. Clinical picture showing epidermoid cyst on 
skin of left side of face              
                         
 
Fig.7B. Photograph showing punctum on the lesion   
  Fig. 8. Clinical picture of epidermoid cyst on left side 
of face over zygomatic arch region. 
 
32 
   IJCDS • MARCH, 2012 • 3(1) © 2012  Int. Journal of Clinical Dental Science 
ETIOPATHOGENESIS  
An epidermal cyst is derived from epidermis, and is 
formed by cystic enclosure of epithelium within dermis 
that becomes filled with keratin and lipid rich debris 
[1]. 
The source of epidermis is nearly always the 
infundibulum of the hair follicle, as there are evidences 
that the lining of the two structures is identical [8]. 
Studies have suggested that human papilloma virus 
and exposure to ultraviolet light may play a role in the 
formation of epidermoid cyst [9, 10, 11, 12]. 
 
CASE REPORTS  
CASE NO. 1: A 65 Year male presented with chief 
complaint of swelling on right ear. Swelling was 
present since last 8 years and was gradually increasing 
in size. Clinically a single, round, yellowish colored, soft, 
nontender swelling of approximately 1cm size was 
present. Swelling was attached to skin of right tragus 
of ear (Fig.1a, 1b). Swelling was excised from its base 
by elliptical incision (Fig 2). Histopathology revealed 
epidermal inclusion cyst. (Fig.3)             
CASE NO.2:  A 40 years old male patient presented 
with two swelling on the skin of forehead. Patient was 
not aware about exact duration of swelling. Clinically, 
swellings were firm, round yellowish colored 
subcutaneous nodules. Punctum was present on both 
the swellings (Fig.4) Swellings were treated by minimal 
invasive technique by giving incision over the central 
part of swelling and enucleating the content and lining 
of the cyst (Fig.5, 6). Histopathological diagnosis was 
epidermal inclusion cyst. 
CASE NO.3: This was a case of small swelling on the 
skin of right cheek in a 70 years old lady Fig. 
7A,7B).Swelling was excised by elliptical incision and on 
histopathological examination it was an epidermal 
inclusion cyst. 
CASE NO.4: A 30 years old male patient presented with 
chief complaint of swelling on right side of face in 
front of ear since 6 years. On clinical examination a 
single, round, firm, mobile swelling of approximate size 
of 3cm was present on right zygomatic arch region (Fig 
8). Skin overlying the swelling was normal in color. 
Clinical diagnosis was epidermoid cyst. Patient has not 
reported for treatment.  
 
DISCUSSION  
Al-khateeb et al [13] in their retrospective study on 
cutaneous cysts of head and neck found that 
epidermoid cyst was most frequent lesion (49%) 
followed by pilar cyst (27%) and dermoid cysts (22%). 
Zide found a similar pattern [1]. 
In an analysis of cutaneous cyst of the head and neck, 
Golden B A, Zide MF [14] found that cheek was the 
most common location for cutaneous cyst. Most 
common site on face is forehead and nasal area. 
Lee HE et al [15] in a study comparing punch and 
elliptical incision for the treatment of epidermoid cyst 
concluded that punch incision produces a superior 
cosmetic result. They recommended that epidermoid 
cyst measuring 1 to 2 cm that are located on face or in 
area of cosmetic concern are best treated with punch 
incision. 
Clinical diagnosis of epidermoid cyst can be confirmed 
at surgery by typical appearance of a cystic lesion filled 
with creamy fluid. Therefore these lesions frequently 
escape histopathological diagnosis. Malignant lesion 
such as basal cell carcinoma and pilomatrix carcinoma 
can mimic cutaneous cyst [1]. So surgical specimens of 
clinically diagnosed epidermoid cysts should always be 
submitted for histopathological examination.  
 
REFERENCES 
1. Fitzpatrick TB (2005). Fitzpatrick’s Color Atlas 
and Synopsis of Clinical Dermatology(ed 5). 
New York, McGraw-Hill. 
2. Barr RJ, Headley JL, Jensen JL, Howell 
JB (1986). Cutaneous keratocysts of nevoid 
basal cell carcinoma syndrome. J Am Acad 
Dermatology. Apr; 14(4):572-6.   
3. Cameron DS, Hilsinger RL Jr (2003).  Squamous 
cell carcinoma in an epidermal inclusion cyst: 
case report. Otolaryngology Head Neck 
Surg. Jul; 129(1):141-3.   
4. Delacretaz J (1977). Keratotic basal-cell 
carcinoma arising from an epidermoid cyst. J 
Dermatol Surg Oncol. May-Jun; 3(3):3.   
5. Lopez-Rios F, Rodriguez-Peralto JL, Castano E, 
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10. Egawa K, Kitasato H, Honda Y, Kawai S, 
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11. Arao T (1990). 'Cystic papilloma' in humans? 
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(12):1599-603.  
12. Lee S, Lee W, Chung S, et al (2003). Detection 
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Epidermoid Cysts of Face: Clinicopathological Presentation and a report of four cases.

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Epidermoid Cysts of Face: Clinicopathological Presentation and a report of four cases.

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