Dermoid Cyst

Dermoid cysts are the most common orbital/periorbital tumors found in the pediatric population. They are slow growing, cystic masses, lined by skin containing oil and skin cells.

What is a Dermoid Cyst? 

Dermoid cysts (also called epidermoid cysts or dermal/epidermal inclusion cysts) are masses, in children and adults, most commonly found in the:

  • Head
  • Face
  • Neck
  • Upper chest

Dermoid cysts are the most common orbital/periorbital tumors found in the pediatric population. They are slow growing, cystic masses, lined by skin containing oil and skin cells.

The term "dermoid cysts" is used to describe:

  • Simple, skin-lined cysts under the skin
  • Cysts with hair follicles
  • Deeper neck cysts with similar contents of oil, skin, and/or hair follicles

The term "dermoid cyst" is also used to describe more complex cystic tumors found in the ovaries of women, which are called ovarian teratoma.

What are the Symptoms of a Dermoid Cyst?

Dermoid cysts outside of the eye produce a painless "mass," or lump, that is felt in the affected area. Dermoid cysts in the eye may produce pressure on the eyeball resulting in pain and visual problems.

The easiest way to think of the cause of a dermoid cyst is "skin being trapped" in the affected area during fetal development. As skin that normally produces oil on the surface and sheds skin cells, a dermoid cyst is thought of as a "bubble" of skin, turned inside-out, and trapped under the skin in otherwise normal tissues.

In this situation, the trapped skin produces oil and skin cells that slowly increase in size as more oil and skin cells are shed into the cyst. As more oil and dermoid skin cells accumulate, the size of the dermoid cyst enlarges. If a dermoid cyst is within the bone (most often in the skull), the hole in the affected bone enlarges as the cyst enlarges.

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Diagnosing Dermoid Cyst

A physician, nurse practitioner, or physician’s assistant makes the diagnosis of a dermoid cyst during a physical examination, when a soft, painless mass is felt in certain areas, with normal overlying skin. The diagnosis of a dermoid cyst is often confirmed with either:

  • Ultrasound
  • MRI
  • CT scan examination

Treating Dermoid Cysts

In the past, the only treatment option for a dermoid cyst was surgical removal of the cyst. If the dermoid cyst is in the bone, surgery includes:

  • Making an incision
  • Opening access to the bone
  • Drilling or scraping the dermoid cyst cells out of the bony cavity

In locations like the forehead and skull, surgical incisions can be wide due to the need to access the cyst.

These therapeutic challenges led to the development of minimally-invasive diagnostic and treatment solutions (drainage and ablation.) There are no treatments using medication for dermoid cysts. Dermoid cysts must either be removed through surgical incisions or ablated (killed) through minimally-invasive drainage and ablation.

What is dermoid cyst ablation?

Dermoid cyst ablation is a minimally-invasive procedure in which a small needle and plastic sleeve enter the dermoid cyst, through which the cyst is killed (ablated) within the body. The body’s own "cleanup" mechanisms then remove the dead dermoid cyst cells during healing. The result leaves a scar the size of a freckle.

How is the procedure performed?

Dermoid cyst ablation begins with drainage of the cyst contents using a technique that "thins" the oily contents with a medical detergent and allows drainage of the cyst contents. After "cleaning" and "removal" of the cyst contents, the collapsed lining membranes (skin cells that line the cyst and produce the cyst contents) that surround the cyst are ablated with a precise needle technique known as "coblation." Using precision ultrasound guidance, the coblation needle tip is placed within the collapsed dermoid cyst and the coblation energy (plasma cloud) destroys the cells of the dermoid cyst.

How long will the dermoid cyst ablation take?

Dermoid cysts ablation is performed in less than 1 hour.

Are there any risks to the procedure?

The primary risk during dermoid cyst ablation is injury to the overlying skin. Skin is protected from injury by injection of sterile fluid that "lifts" the skin away from the coblation energy cloud, providing precise ablation of the dermoid cyst capsule without adjacent skin injury.

What happens after the procedure?

Once the dermoid cyst ablation procedure is completed, the body removes the dead dermoid cyst cells and heals the treatment site. If bone is involved with the dermoid cyst, the bone containing the ablated dermoid cyst heals and new bone forms to fill in the previous defect caused by the dermoid cyst. New bone healing after dermoid cyst ablation may be seen in 2-3 months.

When can my child bathe?

Patients who have undergone dermoid cyst ablation may shower immediately following treatment. They are instructed to refrain from submerging the treated site in a bath for 5 days to allow full healing of the small skin opening used for access to the dermoid cyst.

Are there any activity restrictions?

Aside from keeping the treatment site clean, there are no activity restrictions following dermoid cyst ablation.

Will the dermoid cyst come back after the procedure?

Dermoid cyst ablation is successful in 95% of patients with one treatment session. A second treatment session may be required (5% of patients) if injury to the dermoid cyst occurred prior to treatment resulting in rupture of the dermoid cyst wall (prior to treatment).

What can my child expect after treatment is complete? Any long-term effects?

Results observed in our patients since 2006 have been excellent. All treated patients reported no postoperative pain, infection, swelling, or evidence of inflammatory response. Once ablated and healed, the treated site looks and feels normal.

What happens if a dermoid cyst is left untreated?

Dermoid cysts left untreated will continue to enlarge. If injured and the cyst wall is ruptured, the leaking cyst contents irritate the surrounding tissues causing pain and swelling. Untreated dermoid cysts may occasionally become infected, requiring treatment with antibiotics and more urgent surgical removal or minimally invasive ablation.

Why Nationwide Children's?

The specialties of Interventional Radiology and Plastic Surgery expertly care for children with dermoid cysts.