A Rare Transformation of Epidermoid Cyst into Squamous Cell Carcinoma: A Case Report with Literature Review

Abstract

Patient: Male, 77 Final Diagnosis: Squamous cell carcinoma Symptoms: Epidermoid cyst Medication: — Clinical Procedure: Cyst excision Specialty: Plastic Surgery Objective: Rare co-existance of disease or pathology Background: Epidermoid cysts are the most common benign skin lesions that can occur anywhere on the body, and frequently occur on the face, scalp, neck, and trunk. Typically, patients are asymptomatic, and the lesions present as firm skin-colored nodules filled with keratinous or sebaceous materials that are formed by cystic expansion of the epidermal epithelium. Malignant transformation is rare in epidermoid cysts. Case Report: This is a case report of a 77-year-old male Caucasian patient who presented with an epidermoid cyst on the left parietal area. Due to high suspicion, the cyst was surgically excised and sent to pathology which resulted in discovery of malignant squamous cell carcinoma with unclear margins. Aimed at obtaining clear margins, a wide excision was performed, which revealed clean margins and absence of residual cancerous cells. The patient recovered well without major complications. Conclusions: Although the prevalence of epidermoid cysts is high, malignant transformation of epidermoid cysts into squamous cell carcinoma is rare. Due to its scarcity, the exact pathophysiology of malignant transformation is still poorly understood. The differential diagnosis should include the possibility of malignancy for highly suspicious lesions, and proper management guidelines should be established. Surgical resection should be the treatment of choice, and once removed, all surgically excised cysts should undergo pathologic evaluation. As clinicians, it is crucial to stay vigilant and have a low threshold for excision and thorough histological examination of specimens to allow early diagnosis and interventions which can significantly improve patient outcomes. Through the suggested guidelines, we hope to aid in better management and intervention in case of malignant transformation of epidermoid cysts.

Palati̇n Tonsi̇l'i̇n Epi̇dermoi̇d Ki̇sti̇: Rastlantisal Nadi̇r Bi̇r Durum Ve Li̇teratürün Gözden Geçi̇ri̇lmesi̇

“…It is known that rarely squamous cell carcinoma can develop from epidermoid cysts (20). However, in these 12 cases in the literature, dysplasia and malignancy were not observed in the epithelium.…”

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“…5 Also, the malignant degeneration of the epidermoid cysts is described what required a wide excision of the tumor (with a small possibility of radiation therapy after surgery) or radiation therapy as a primary treatment. 10 Multiple works reported carcinomas arising from epidermoid/sebaceous cysts (patients` age varied from 21 to 89 yrs) what required from surgeons to motivate patients to remove the cysts as soon as possible. [10][11][12][13][14][15] Veenstra et al summarized global literature presenting the data that squamous cell carcinoma arising from epidermal cysts has an incidence ranging from 0.011 to 0.045 percent.…”

Contrast-enhanced computed tomography findings of a huge perianal epidermoid cyst: A case report

“…Usually the cysts are slow-growing and asymptomatic. Pain and tenderness may be felt if the cysts are infected and inflamed, or develop into a malignancy, which is rare[1].…”

“…Epidermoid cysts usually are benign cysts that are commonly found in the skin, including on the face, scalp, neck, and trunk[1]. However, perianal epidermoid cysts are very rare and a few cases have been reported on[2].…”