Multiple Epidermal Cysts of the Scalp: Dermatosurgical Approach with Favourable Outcome!

Abstract

BACKGROUND: Epidermal cysts are subcutaneous tissue formations that are most commonly located in the area of scalp, trunk and face. In addition to single ones, the cysts may also be multiple, located near each other. Although they are considered to be a cystic ectasia of the hair infundibulum and mainly affect hairy parts, they can also be seen in the area of palms and feet as a result of trauma. Rare extracutaneous localisations are also described in the medical literature, affecting the oral cavity, intraosseous, cerebrum and sublingual epidermoid cyst. Although the majority of epidermal cysts are benign, a malignant transformation may also occur in the direction of development of squamous cell carcinoma, basal cell carcinoma or Merkel cell carcinoma. Clinically, they are presented as benign lesions, and only histological examination may reveal their malignant potential. Therefore, their surgical removal and subsequent histology are of paramount importance for the elucidation of their origin.
 CASE PRESENTATION: An 88-year old patient was hospitalized for surgical removal of two tumorous formations in the head area which have been available for many years. During the dermatological examination in the frontal and parietal area of the head, the presence of two oval pink cystic neoplasms, clinically suspected for epidermal cysts, was found. The lesion located in the frontal area was removed by elliptical excision. The resulting surgical defect was closed by undermining the wound edges and mobilisation of the released skin to the middle of the defect, as the latter being closed by single interrupted sutures. In the second surgical session, the lesion located in the parietal region of the head was also removed under local anaesthesia. A so-called island flap was performed in which the tumour formation was removed by oval excision followed by contouring a triangle in the distal direction and transposition of the undermined triangle to the oval surgical defect. The resulting defect was recovered by single interrupted sutures.
 CONCLUSION: First-line treatment of epidermal cysts is surgical excision, and it is important to remove the cyst wall to minimise the risk of relapses and recurrence. Other treatment options include laser therapy with CO2, erbium-YAG laser or intralesional drainage injection of triamcinolone acetonide.

Unusual giant plunging sublingual epidermoid cyst: A case report and review of literature

“…Surgical excision is the preferred treatment modality, with the aim of complete removal of the cyst wall while avoiding rupture to prevent postoperative inflammation 10,13,14 . The use of a CO2 laser is an alternative to conventional surgery, enabling precise tissue dissection and minimizing trauma, as was performed in this case 14 .…”

Diagnosis and therapy of giant epidermoid double cysts with infection on the buttock: A case report and literature review

“…Multiple EC is rare, [ 24 ] often located in the head and face. [ 25 ] Most patients have a history of acne. [ 26 , 27 ] Although EC is a common skin lesion, it rarely becomes malignant.…”

A Rare Case of Facial Multiple Epidermal Cysts: Successfully Treated by Surgical Excision

“…Epidermal cysts are keratin-lled epithelial-lined cysts, which are most commonly located in the area of face, scalp, neck, back and trunk, rarely seen in the area of palms and feet [1]. Epidermal cysts are usually single, and few cases have reported multiple epidermal cysts that occurred at the same site before [2].…”