Dermoid Cyst

  • What is a dermoid cyst?

    A dermoid cyst is a pocket or cavity under the skin that contains tissues normally present in the outer layers of the skin. The pocket forms a mass that is sometimes visible at birth or in early infancy but often is not seen until later years.

    Dermoid cysts are usually found on the head or neck, and sometimes on the face, commonly in or near the eyebrow.

  • Causes

    A dermoid cyst is congenital (present from birth), occurring during embryonic development when the skin layers do not properly grow together. A dermoid cyst is lined with epithelium, which is a layer of skin that constantly sheds dead cells. In the cyst, instead of shedding the cells to the outside of the body, the cyst fills up with the dead cells and the cyst gets bigger.

  • Symptoms

    The following are the most common symptoms of a dermoid cyst. However, each child may experience symptoms differently.

    Symptoms may include:

    • A small, often painless, lump often located on the neck, scalp, forehead, nose or around the eye (in which the skin over the lump can easily be moved)
    • The lump may be skin-colored, or may have a slight yellow tinge
    • These cysts can sometimes get so large that if they are near a child’s eye — such as an eyebrow — it can be difficult for your child to open that eye

    The symptoms of a dermoid cyst may resemble other neck masses or medical problems. Always consult your child’s physician for a diagnosis.

  • Diagnosis

    Dermoid cysts are diagnosed by physical examination. Generally, the mass can be easily moved beneath the skin, and is painless.

    In addition to a complete medical history and physical examination, diagnostic procedures to determine if the cyst is connected to other tissues in the head and neck may include a CT scan or MRI.

    At CHOP, we see a great number of patients with cysts such as the dermoid cyst. We use additional testing as needed to make an accurate assessment, then present you with treatment options based on your child’s results.

  • Treatment

    Specific treatment of a dermoid cyst will be determined by your child's physician based on:

    • Your child’s age, overall health and medical history
    • Extent of the condition
    • Location of the cyst
    • Your child’s tolerance for specific medications, procedures or therapies
    • Expectations for the course of the condition
    • Your opinion or preference

    Dermoid cysts tend to enlarge slowly over time, so treatment frequently includes surgery to remove the cyst when it is first detected. Aspirating the cyst with a needle, or lancing/draining it is not an option because the cyst lining needs to be removed in order for it to not grow back.

    Depending on the location of your child’s cyst, she may see one of our pediatric general surgeons, a plastic and reconstructive surgeon, a neurosurgeon, or a combination of these experts to best treat her unique condition.

    For cysts in and around the eye, the most common location, excision can frequently be accomplished through a lid incision performed by one of our plastic and reconstructive surgeons. A direct incision over the cyst may be required. Scars are designed to fall into creases and folds to look as natural as possible.

    Dermoid cysts that occur in the middle of the face may present as masses in the area between the eyes and on the nose or small sinuses. Because of the location, cysts in this region are evaluated with an MRI to determine if the cysts are attached to the brain. If a simple cyst is outside the bone of the skull, direct excision of the cyst through an incision in the skin is all that is required.

    Any connection with the skull requires a more complex procedure performed with a neurosurgeon. The involved skin, the cyst, and any connection through bone into the brain are removed together through an incision in the skin coupled with an intracranial approach.

    What to expect during your child’s surgery

    Surgery to remove a dermoid cyst is typically done as an outpatient procedure. You will bring your child to the hospital or surgery center, where you will meet with a surgeon and a surgical nurse practitioner. The day’s surgery, preparation and follow up will be explained to you in detail and you will have a chance to ask any questions you have.

    After all pre-surgical prep is done, your child will be put under general anesthesia and the cyst will be removed. Your child will be monitored before, during and after the procedure. Once he or she has recovered from the anesthesia, your child will return home.

  • Follow-up care

    Your child will return for a follow-up visit to check the incision, but typically there is no need for additional monitoring or treatment.

Reviewed by Karen Barnaby, RN, MSN, CRNP, Peter Mattei, MD, FACS, FAAP on February 01, 2012