“…Most frequently, an epidermal cyst occurs on the face, scalp, neck, and trunk; perineal involvement is very rare ( 3 ). Although intracystic hemorrhage and malignant transformation of epidermoid cysts are unexpected, a few cases are reported in the literature ( 1 , 2 , 3 ). The differential diagnosis of perineal cysts should consider the following: abscess, pilonidal cyst/sinus; hidradenitis; trauma; perianal dermatoses, including anal duct/gland cysts; benign teratomas; and anal/skin cancer, including malignant teratomas and teratomas with malignant transformation ( 4 ).…”