Cutaneous Cysts

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Epidermoid cyst (50,51) is a common cutaneous tumor derived from squamous epithelium. It is skin-colored or yellowish, dome-shaped, smooth, mobile, and ranges in size from 0.5 to 5 cm in diameter. Many lesions have a characteristic central punc-tum from which a cheeselike material can be expressed. They usually appear on the face or trunk. Epidermoid cysts develop in patients with acne conglobata or by implantation of squamous epithelium into the dermis secondary to sharp injury or trauma. Lesions are often inflamed or infected. The presence of multiple cysts is suggestive of Gardner's syndrome, which incorporates intestinal fibromatosis, jaw osteomas, and colonic polyps. Histological examination shows a cystic cavity lined by keratinizing squamous epithelium with intact granulosa, and the cavity is filled with well-defined keratin lamellae.

Milia cysts (52) are white or cream in color and are known as white heads. a

They frequently appear in patients with acne, after application of occlusive ointments following resurfacing procedures, in patients with certain blistering diseases such as porphyria or bullous pemphigoid, and as a manifestation of chronic solar damage. On histological examination milia cysts are identical to epidermoid cysts.

Pilar cyst (trichilemmal cyst) is similar to its epidermoid counterpart but much less frequent (ratio 3:1). It affects the scalp (90%) and is frequently multiple (30%). On histological examination the cyst wall shows peripheral palisading of clear cells,

Sequestration Dermoid
Figure 15 Dermoid cysts occur along lines of embryonic fusion. Location on the eyebrow region is characteristic.

has no granular layer, and the cystic cavity is filled with homogeneous horny material, not lamellae.

Dermoid cysts result from the sequestration of skin along lines of embryonic fusion. They are present at birth, usually around the eyes or nose (Fig. 15). Histolo-gical examination shows a cystic cavity lined by epidermis containing various skin appendages (hair, sebaceous and sweat glands).

Steatocystoma multiplex (53) is a true sebaceous cyst that occurs during adolescence as an autosomal dominant condition. Tumors are multiple, smooth, yellowish, or skin-colored, measuring from 0.3 to 3 cm in diameter, and with surface telangiectasias. The most common locations are the scrotum, axillae, chest, or neck. On histological examination these cysts are considered a variant of dermoid cysts because the wall contains multiple sebaceous glands.

Oral mucous cyst (mucocele) develops after the rupture of an obstructed salivary duct (54). On clinical examination the tumor is soft, approximately 1 cm or less -g in diameter, cystic in consistency, and fluctuant. Lesions affect the lower lip, are asymptomatic, and red or blue. On histopathological examination there are multiple cystic spaces filled with sialomucin surrounded by granulation tissue.

Mucous cyst of the finger represents either an overproduction of hyaluronic d acid or a leakage of hyaluronic acid from the interphalangeal joint. Lesions are firm, >3

skin-colored, well circumscribed, and located on the dorsal aspect of the distant pha- |

lanx of fingers. On histological examination there is a cystic cavity filled with mucin.

Bronchogenic cysts (55) are small, subcutaneous, solitary lesions located in the area of the sternal notch. They appear at birth and may have a draining sinus.

Thyroglossal duct cysts are clinically identical to bronchogenic cysts but located on the anterior aspect of the neck. On histological examination bronchogenic cysts are lined by pseudostratified columnar epithelium. Thyroglossal duct cysts lack muscle tissue but contain thyroid follicles.

Cysts have no malignant potential. Surgical excision is the treatment of choice for diagnostic or cosmetic reasons.

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