KÜ Tıp Fak Derg 2010; 12(1) ISSN 1302-3314 Olgu Sunumu 23 A Step-by-step Visualization of an Epidermal Cyst Excision on the Neck and Review of Literature Özgür GÜNDÜZ * , Deniz ÖZTÜRK KARA * , Pınar ATASOY ** * Department of Dermatology and Venerology - University of Kırıkkale, Kırıkkale, TURKEY ** Department of Pathology, University of Kırıkkale, Kırıkkale, TURKEY Abstract; Although epidermal inclusion cysts (EIC) are relatively common and usually not paid their deserved medical attention. Extending from a simple inflammation to carsinogenesis 1-3 , the complication spectrum of EIC is very wide. In this paper, we report a young adult patient with an EIC on his neck with an emphasis on the excisional procedure and histopathology. Key Words: Epidermal inclusion cyst, traumatic implantation, congenital etiology, granular layer, lamellated keratin, en- bloc excision, minimal incision technique A Step-by-step Visualization of an Epidermal Cyst Excision on the Neck and Review of Literature Özet ; Epidermal inklüzyon kistleri (EİK), göreceli olarak sık görülen lezyonlar olmalarına rağmen hak ettikleri medikal önemi görmemektedirler. EİK, basit bir inflamasyondan karsinogenezise 1-3 zemin oluşturmaya kadar oldukça geniş bir komplikasyon profiline sahiptir. Bu makalede, boynunda EİK tespit edilen genç erişkin bir erkek hastada uygulanan eksizyon prosedürü ve EİK’in histopatolojisi anlatılmaktadır. Anahtar Kelimeler: Epidermal inklüzyon kisti, travmatik implantasyon, konjenital etyoloji, granüler tabaka, lamellar keratin, en-bloc eskizyon, minimal insizyon tekniği Introduction EICs, also erroneously referred as “sebaceous cyst”, are practically the most common cysts of cutaneous origin in humans. 1,2,3 Although not a strict rule, hair-bearing areas are more likely to develop such lesions, so a good portion of cysts are located on visible areas. Besides the cosmetic discomfort caused by epidermal cysts (due to an altered appearance), there are other possible complications, foremost being the infections of the cystic cavity due to its connection with the skin surface. Infected cysts may cause considerable pain and impairment during daily activities. An infected epidermal cyst is considered as prone to recurrent infections. Also risk of malign degeneration in the cyst setting is another uncommon, but serious threat. Methods A 22-year old male patient presented with a bulging lesion on his right side of neck. He was worried about this asymptomatic, but persistant lump which occurred 2 years before. His further medical history revealed only prior acne treatment consisting of topical and systemic antibiotics (erythromycin, doxycycline respectively) and topical retinoids. A solitary non-tender, nodulocystic lesion with limited mobility and 1.0 cm. radius was observed on the right side of the patient’ neck (Fig.1.a.). Although asymptomatic, the cyst was a major source of discomfort for the patient. An excisional biopsy was planned. After a discussion about all the possible complications of the procedure, an informed consent was taken from the patient. The operation was performed in the outpatient clinic of Kirikkale University Department of Dermatology and Venerology. Operational area was scrubbed initially with alcohol. Then the excision margins were determined and excision lines were drawn according to the relaxed tension skin lines with a sterilized pen (Fig 1.b). An anesthetic solution consisting of Lidocaine HCl 20 mg/ml, Epinephrine HCI 0.0125 mg/ml was employed for the local infiltration anesthesia in a fan-shaped manner in the perioperational area and under the cyst (Fig 1.c – 1.d). A total dose of 5 ml of anesthetic solution was injected. This relative excess dose of epinephrine containing solution was preferred for a more gentle and easy separation of the cyst from the underlying tissues by inducing a hydrodissection on a smaller scale. Also epinephrine’s vasoconstructive effect enabled us to work on a relative bloodless operative field and a longer operation time. After the local anesthesia, the surgery area was scrubbed with