Overview

A dermoid cyst is a benign (non-cancerous) growth that contains a mixture of tissues such as hair, skin, teeth, and fat. These cysts are congenital, meaning they develop before birth, and arise from trapped skin and other tissues during fetal development. Dermoid cysts can appear anywhere in the body but are most commonly found on the face, neck, scalp, ovaries, and spine. They are generally slow-growing and often painless, but depending on their size and location, they can cause discomfort or complications. While dermoid cysts are usually harmless, surgical removal is often recommended to prevent complications like infection or rupture.

Causes

Dermoid cysts develop due to developmental anomalies during embryonic growth. The exact causes include:

• Embryonic Tissue Trapping: During fetal development, skin cells and tissues can get trapped in the wrong location, leading to the formation of a cyst that contains skin-related structures like hair follicles and sebaceous (oil) glands.
• Congenital Condition: Most dermoid cysts are congenital, meaning they are present from birth, though they may not become noticeable until later in life.
• Ovarian Dermoid Cysts (Mature Teratomas): In women, dermoid cysts commonly occur in the ovaries and are composed of tissues from multiple germ layers, including hair, fat, and sometimes teeth.
• No Known Environmental Triggers: Dermoid cysts are not caused by infections, lifestyle choices, or environmental factors, and there is no known method of prevention.

Symptoms

Symptoms of a dermoid cyst depend on its location, size, and whether it causes pressure on surrounding tissues. Common symptoms include:

• Visible Lump: A noticeable, round, firm, and often painless lump under the skin, especially on the face, scalp, neck, or back.
• Facial Dermoid Cysts: May cause swelling near the eyes, nose, or forehead, sometimes leading to cosmetic concerns.
• Ovarian Dermoid Cysts: Can cause pelvic pain, bloating, irregular menstruation, or discomfort during intercourse if they grow large.
• Spinal Dermoid Cysts: Rarely, dermoid cysts can develop along the spinal cord, potentially causing back pain, weakness, or neurological symptoms.
• Infection Symptoms: If a dermoid cyst becomes infected, it may cause redness, tenderness, warmth, and discharge of foul-smelling material.
• Rupture or Torsion: Ovarian dermoid cysts can sometimes twist (torsion) or rupture, leading to severe abdominal pain and requiring emergency medical attention.

Diagnosis

Diagnosing a dermoid cyst typically involves a physical examination and imaging tests to determine the cyst's nature and location:

• Physical Examination: The doctor examines the lump's size, consistency, and mobility during a clinical assessment.
• Ultrasound: Commonly used to assess ovarian or superficial dermoid cysts by showing their internal structure and content.
• MRI (Magnetic Resonance Imaging): Offers detailed images of deeper or complex cysts, especially near the spine or brain.
• CT Scan (Computed Tomography): Useful for determining the exact size and composition of cysts, particularly in the pelvic or abdominal area.
• Histological Examination: After surgical removal, the cyst is often sent for histopathological analysis to confirm the diagnosis and rule out malignancy.

Treatment

The primary treatment for dermoid cysts is surgical removal, especially if the cyst causes symptoms or cosmetic concerns:

• Surgical Excision:
  • Facial or Scalp Dermoid Cysts: Typically removed through a small incision under local or general anesthesia, minimizing scarring.
  • Ovarian Dermoid Cysts: Laparoscopic (minimally invasive) or open surgery may be performed to remove the cyst while preserving ovarian function whenever possible.
  • Spinal Dermoid Cysts: Require neurosurgical intervention to safely remove the cyst while protecting nerve structures.
• Monitoring: Small, asymptomatic dermoid cysts may be monitored over time, especially in individuals at higher surgical risk.
• Treatment of Complications: In cases of infection, antibiotics may be prescribed before surgical intervention. Emergency surgery is required if there is torsion or rupture.

Prognosis

The prognosis for dermoid cysts is generally excellent after surgical removal:

• Benign Nature: Dermoid cysts are almost always non-cancerous, and complete removal usually resolves symptoms without recurrence.
• Low Recurrence Rate: Recurrence is rare if the cyst is completely excised. Incomplete removal may lead to regrowth.
• Post-Surgery Recovery: Most people recover fully within a few weeks after minor surgical procedures, with minimal risk of complications.
• Complications: Complications like rupture, torsion, or infection are uncommon but can be serious if not promptly treated.
• Ovarian Function: In most cases, ovarian function is preserved after removal of ovarian dermoid cysts, allowing women to maintain fertility.

Overall, with appropriate medical care and timely surgical intervention, individuals with dermoid cysts can expect excellent outcomes and minimal impact on their long-term health.