The image shows the presence of a dense, nodular, and diffuse infiltrate in the dermis. Note the presence of germinal centers (hematoxylin-eosin, original magnification ×20).

Malignant degeneration within epidermal cysts is very rare. However, these lesions may not be recognised clinically, and histological examination plays an important role in arriving at a correct diagnosis. Hence, we believe that benign-looking cystic lesions with a history of progressive growth should be surgically excised and submitted for histopathological assessment.