International Surgery Journal | April 2020 | Vol 7 | Issue 4 Page 1332 International Surgery Journal Vagholkar K et al. Int Surg J. 2020 Apr;7(4):1332-1334 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Review Article Therapeutic approach to epidermoid cyst Ketan Vagholkar*, Suvarna Vagholkar INTRODUCTION Epidermoid cyst also known as sebaceous cyst is one of the commonest swelling arising from the skin. It is commonly located over the face, neck, back and scrotum. 1,2 The cyst has tendency to grow slowly over a period of time. Malignant change rarely occurs in sebaceous cyst. 2 ETIOPATHOGENESIS The term sebaceous cyst is a misnomer. True sebaceous cysts which originate from the sebaceous glands are extremely rare and are described as steatocystoma simplex or steatocystoma multiplex if multiple. Epidermoid cysts originate in the epidermis whereas pilar cysts originate from the hair follicle. Epidermoid cysts typically occur in the third to fifth decades of life. They are more commonly seen in males. Less than 1% of these cysts can undergo malignant transformation either to a squamous cell carcinoma or a basal cell carcinoma. 1-3 There is a heredofamilial tendency in a few cases. It is seen in autosomal dominant conditions such as Gardner’s syndrome (familial polyposis of the colon) or Gorlin’s syndrome (basal cell nevus syndrome). 2 Cyst developing before puberty in uncommon locations and numbers should raise the suspicion of these syndromes. Epidermoid cysts may occur in elderly individuals with chronic sun exposure as seen in Favre-Racouchot syndrome characterized by nodular elastosis with cysts and comedones. 2 Infection with HPV has also been implicated in the development of cysts. Patients on drugs such as BRAF inhibitors, cyclosporine and imiquimod have a high incidence of developing inclusion epidermal cysts. 3-6 Epidermoid cysts originate from the follicular infundibulum. Plugging of the follicular orifice leads to the formation of a cyst. The cyst communicates with the surface of the skin by way of an orifice which is invariably blocked by keratin. Epidermoid cysts are lined by stratified squamous epithelium thereby leading to accumulation of keratin within the dermis. Rupture of the cyst leads to an inflammatory reaction involving the dermis and subcutaneous tissues. Histopathological examination of the cyst reveals peculiar features. The cyst is lined by stratified squamous epithelium which is similar to the surface epithelium except for rete pegs which are absent and contains laminated keratin which usually lies at the ABSTRACT Epidermoid cyst is one of the commonest cutaneous swelling treated by a general surgeon. It is usually misnamed as a sebaceous cyst. Understanding the anatomical origin and pathogenesis of the cyst is pivotal for diagnosis and successful treatment. The etiopathogenesis, clinical features and surgical approach is presented in this paper. Keywords: Diagnosis, Epidermoid cyst, Treatment Department of Surgery D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India Received: 06 March 2020 Revised: 19 March 2020 Accepted: 21 March 2020 *Correspondence: Dr. Ketan Vagholkar, E-mail: kvagholkar@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20201421