Aesthetic Reconstruction After Removal of Huge Epidermal Cyst Involving the Calvarium and Dura on the Scalp

Abstract

Epidermal or epidermoid cysts are one of the most frequent benign masses at the subepidermal level. They are typically smooth, movable, and fluctuant masses covered with stratified squamous epithelium. They rarely grow to a huge size, and only a few cases have been reported. A 69-year-old woman visited the authors’ clinic for treatment of a well-defined huge mass in the right temporoparietal and occipital regions of the scalp that had regrown and spontaneously increased in size after excision 30 years prior. Computed tomography revealed a large lobulated mass with an air-fluid level and calvarial bone erosion invading the inner table in the right parietal region. Dural exposure was suspected based on magnetic resonance imaging, which depicted diffuse dural thickening with enhancement. The authors aesthetically excised the mass in cooperation with the Department of Neurosurgery using an inverted T-shaped excisional flap design for the reduction of the redundant scalp similar to that used in reduction mammoplasty surgery. Two months later there was no evidence of recurrence or complications, and the patient was satisfied with the results of the surgery. The authors report the case of a huge scalp mass with skull defect and propose an aesthetic treatment option for this unusual mass on the scalp.