Torbiel naskórkowa
Patofizjologia i mechanizm

Torbiel naskórkowa (epidermoid cyst) to łagodna zmiana skórna wywodząca się z nabłonka wielowarstwowego płaskiego, najczęściej z lejkowej części mieszka włosowego, charakteryzująca się nagromadzeniem keratyny w warstwie podnaskórkowej lub skórze właściwej. Klinicznie manifestuje się jako dobrze odgraniczony guzek podskórny o średnicy od kilku milimetrów do 5 cm, z punktem centralnym, lokalizujący się najczęściej na twarzy, szyi, tułowiu i plecach. Patogeneza jest wieloczynnikowa i obejmuje mechanizmy takie jak zaczopowanie ujścia mieszka włosowego, urazowa implantacja nabłonka w skórze właściwej, zakażenie HPV (szczególnie typ 57) oraz ekspozycja na promieniowanie UV. W badaniach histopatologicznych torbiel wykazuje wyściółkę z nabłonka wielowarstwowego płaskiego z warstwą ziarnistą, wypełnioną warstwowo ułożoną keratyną, a w obrazowaniu MRI często obserwuje się obwodową strukturę wyściełającą o niskiej intensywności sygnału w obrazach T2-zależnych (w 76% przypadków). Transformacja złośliwa jest rzadka (ok. 1%), a przewlekły stan zapalny i urazy mogą predysponować do rozwoju raka płaskonabłonkowego.

  1. Patogeneza torbieli naskórkowej
    1. Mechanizm powstawania z jednostki włosowo-łojowej
    2. Implantacja urazowa jako mechanizm patogenetyczny
    3. Zaburzenia embriogenezy jako przyczyna torbieli naskórkowych
    4. Czynniki indukujące torbiele naskórkowe
    5. Mechanizm zapalny w patogenezie torbieli naskórkowych
    6. Transformacja złośliwa torbieli naskórkowych
  2. Czynniki genetyczne w patogenezie torbieli naskórkowych
    1. Molekularne aspekty patogenezy torbieli naskórkowych
  3. Charakterystyka histopatologiczna torbieli naskórkowych
    1. Różnice histopatologiczne między rodzajami torbieli
  4. Czynniki ryzyka i lokalizacja torbieli naskórkowych
    1. Mechanizm wzrostu i objawy kliniczne
  5. Powikłania i leczenie torbieli naskórkowych
    1. Zalecenia dotyczące postępowania z torbielami naskórkowymi
    2. Kolejne rozdziały

Patogeneza torbieli naskórkowej

Torbiel naskórkowa (epidermoid cyst) to łagodna zmiana skórna pochodzenia nabłonkowego, która rozwija się z proliferacji komórek naskórka w obrębie zamkniętej przestrzeni skóry właściwej. Analiza profilu lipidowego tych torbieli wykazuje podobieństwa do naskórka. Dodatkowo torbiele naskórkowe wykazują ekspresję cytokeratyn 1 i 10, które są składnikami warstw nadpodstawnych naskórka.1 Mechanizmy patogenetyczne powstawania torbieli naskórkowych są złożone i ciągle badane, lecz wyróżnia się kilka głównych ścieżek rozwoju.

Mechanizm powstawania z jednostki włosowo-łojowej

Najczęstszym źródłem torbieli naskórkowych jest lejek mieszka włosowego (infundibulum folliculi). Torbiele te są zazwyczaj wynikiem zaczopowania ujścia mieszka włosowego. Lejek mieszka włosowego dzięki swojej charakterystycznej strukturze stanowi idealne miejsce do powstawania torbieli – wyściółka torbieli naskórkowej jest identyczna z wyściółką lejka mieszka włosowego, co potwierdza jego udział w patogenezie.23

Torbiel komunikuje się z powierzchnią skóry przez otwór wypełniony keratyną. Zaburzenie struktury mieszka włosowego odgrywa ważną rolę w patogenezie – pacjenci z trądzikiem pospolitym mogą mieć liczne torbiele naskórkowe pochodzące z zaskórników.4 W torbieli dochodzi do gromadzenia keratyny w warstwie podnaskórkowej lub skórze właściwej. Torbiele są zazwyczaj bezobjawowe, dopóki nie dojdzie do ich pęknięcia. W momencie pęknięcia torbieli dochodzi do reakcji zapalnej spowodowanej przemieszczeniem miękkiej, żółtej keratyny do skóry właściwej i otaczających tkanek.5

Implantacja urazowa jako mechanizm patogenetyczny

Torbiele naskórkowe mogą powstawać również w wyniku urazów i obrażeń penetrujących, prowadzących do implantacji nabłonka w głębsze warstwy skóry.6 Ten mechanizm patogenetyczny jest szczególnie istotny w przypadku torbieli naskórkowych występujących w miejscach nieowłosionych, takich jak dłonie czy podeszwy stóp.7 Prawdziwe torbiele inkluzyjne powstają w wyniku implantacji elementów nabłonkowych w skórze właściwej. Niektóre urazy, szczególnie typu zmiażdżeniowego, są związane z torbielami naskórkowymi paznokcia lub paliczka dystalnego. Często zgłaszanym mechanizmem jest uraz zmiażdżeniowy wywołany zatrzaśnięciem palca w drzwiach samochodu.8

Każda procedura chirurgiczna może teoretycznie prowadzić do powstania torbieli naskórkowych. Opisano tworzenie się wielu torbieli naskórkowych po rynoplastyce, powiększaniu piersi i liposukcji.9 W przypadku torbieli naskórkowych podeszwy, badania mikroskopowe, immunohistochemiczne i molekularne sugerują, że mogą one być indukowane przez wirusa brodawczaka ludzkiego (HPV).10

Zaburzenia embriogenezy jako przyczyna torbieli naskórkowych

Torbiele naskórkowe mogą powstawać również w wyniku sekwestracji resztek naskórkowych podczas życia płodowego lub nieprawidłowej embriogenezy podczas różnicowania komórkowego.11 W przypadku torbieli wewnątrzczaszkowych, uważa się, że powstają one z zatrzymanego nabłonka ektodermalnego podczas zamykania cewy nerwowej między trzecim a piątym tygodniem ciąży.12

W szczególnych przypadkach, jak np. torbiele kątnicze (cecal epidermoid cysts), proponuje się dwa mechanizmy patogenetyczne dla sekwestracji wrodzonej. Jeden z mechanizmów sugeruje, że implantacja ektodermalna zachodzi w momencie zamknięcia bruzdy nerwowej podczas embriogenezy. Inny mechanizm mówi, że pochodzenie wrodzonej tkanki heterotopowej może mieć miejsce podczas wewnątrzmacicznej rotacji jelit z powrotem do jamy brzusznej, szczególnie że kątnica jest jednym z ostatnich elementów ponownie wchodzących do jamy brzusznej.13

Czynniki indukujące torbiele naskórkowe

Ostatnio promieniowanie ultrafioletowe (UV) i zakażenie wirusem brodawczaka ludzkiego (HPV) zostały wskazane jako czynniki wywołujące torbiele naskórkowe.14 Badania sugerują, że HPV i ekspozycja na promieniowanie UV mogą odgrywać rolę w powstawaniu niektórych torbieli naskórkowych, szczególnie torbieli brodawkowych z grubą hipergranulocytozą.15

Kilka badań wykazało dowody na zakażenie HPV w torbielach naskórkowych dłoni i podeszwy stóp oraz kończyn, szczególnie u pacjentów zakażonych HPV typu 57, co dodatkowo sugeruje, że zakażenie HPV może być związane z patogenezą torbieli naskórkowych.16 Zaobserwowano, że torbiele naskórkowe podeszwy przyczepione są do lub znajdują się w pobliżu przewodów egzokrynnych, co sugeruje, że mogą pochodzić z przewodów egzokrynnych.17

Mechanizm zapalny w patogenezie torbieli naskórkowych

Gdy torbiele naskórkowe stają się zapalne, wielu klinicystów zakłada, że doszło do zakażenia. Jednak dowody na to założenie są skąpe.18 Badania wykazały, że kolonizacja bakteryjna zapalnych i niezapalnych torbieli naskórkowych jest powszechna. Ponieważ ani liczba, ani rodzaj organizmów nie zmienia się podczas zapalenia, prawdopodobnie za zapalenie odpowiedzialna jest inna przyczyna niż zakażenie. Autorzy wysuwają hipotezę, że ściana torbieli może pęknąć, wydzielając swoją zawartość do skóry właściwej.19

Badania podkreślają przewagę beztlenowców w zapalnych torbielach naskórkowych, co silnie sugeruje, że zakażenie bakteriami beztlenowymi może odgrywać znaczącą rolę w procesie zapalnym.20 Proces zapalny może nie być prostym bakteryjnym zakażeniem skóry; mikroorganizmy mogą jednak mieć pewien wpływ na mechanizm zapalenia torbieli naskórkowych.21

Transformacja złośliwa torbieli naskórkowych

Transformacja złośliwa torbieli naskórkowych jest niezwykle rzadka (1% przypadków).22 Chociaż dokładny mechanizm pozostaje niejasny, zasugerowano zaangażowanie przewlekłego stanu zapalnego spowodowanego pozostałościami składników torbieli, szczególnie w długotrwałych zmianach, w ogólnej etiologii karcinogenezy komórek płaskonabłonkowych.23

Sposób, w jaki raki mogą powstawać w torbielach naskórkowych, jest niejasny. W serii torbieli naskórkowych z rakiem, wyniki immunohistochemiczne dla HPV były negatywne, co sugeruje, że HPV prawdopodobnie nie odgrywa roli w rozwoju raka płaskonabłonkowego w torbielach naskórkowych. Zasugerowano, że przewlekłe podrażnienie lub powtarzający się uraz nabłonka wyściełającego torbiel może odgrywać rolę w transformacji złośliwej; jednak związek ten nie został ustalony.24

Wiadomo jednak, że rak płaskonabłonkowy częściej rozwija się na uszkodzonej lub przewlekle chorej skórze.25 W niektórych przypadkach u pacjentów z torbielami naskórkowymi dochodzi do długotrwałego podrażnienia tkanki w miejscu nacięcia ściany torbieli przez zawartość torbieli, powodującego przewlekłe reakcje zapalne, które defosforylują cienką warstwę nabłonka płaskiego, ostatecznie prowadząc do złośliwej transformacji torbieli naskórkowej i powstania raka płaskonabłonkowego.26

Czynniki genetyczne w patogenezie torbieli naskórkowych

Większość przypadków torbieli naskórkowych jest sporadyczna. Torbiele naskórkowe mogą być jednak związane z pewnymi dziedzicznymi zespołami.27 Do takich zespołów należą:

282930

Torbiele naskórkowe występujące przed okresem dojrzewania w nietypowych lokalizacjach i w dużej liczbie budzą podejrzenie zespołu genetycznego.31 U pacjentów leczonych inhibitorami BRAF mogą rozwijać się torbiele naskórkowe twarzy. Ostatnio zaobserwowano, że imikwimod i cyklosporyna mogą powodować torbiele inkluzyjne naskórka.32

Molekularne aspekty patogenezy torbieli naskórkowych

Na poziomie molekularnym torbiele naskórkowe wewnątrzczaszkowe charakteryzują się zmienionym repertuarem immunologicznym. Duże obciążenie mutacyjne obserwowane w genach HLA i KIR sugeruje, że geny te mogą być zaangażowane w mechanizmy unikania odpowiedzi immunologicznej w torbielach naskórkowych wewnątrzczaszkowych.33

Analiza wzbogacania ścieżek sygnałowych dla zmienionych genów zidentyfikowanych w torbielach naskórkowych wewnątrzczaszkowych wykazała silny związek z kompleksem MHC. Analiza wzbogacania ścieżek wskazała na zaangażowanie w przetwarzanie i prezentację antygenów, receptor ECM, ogniskową adhezję, a także szlak sygnałowy PI3K-Akt-mTOR.34

Charakterystyka histopatologiczna torbieli naskórkowych

Torbiele naskórkowe wyścielone są nabłonkiem wielowarstwowym płaskim, który prowadzi do nagromadzenia keratyny w warstwie podnaskórkowej lub skórze właściwej.35 Są zlokalizowane w środkowej i dolnej warstwie skóry właściwej. Charakteryzują się typową rogowaciejącą naskórkową wyściółką spłaszczonego nabłonka powierzchniowego. Z tego powodu uważa się, że pochodzą z lejkowej części mieszka włosowego lub naśladują tę strukturę.36

Cechy histopatologiczne torbieli naskórkowej to:

  • Torbiel wyścielona nabłonkiem wielowarstwowym płaskim z warstwą ziarnistą
  • Wypełnienie materiałem keratynowym ułożonym warstwowo
  • Dobrze odgraniczona ściana torbieli
  • Widoczne ziarnistości keratohialinowe
  • Spłaszczony nabłonek powierzchniowy

373839

Zawartość keratynowa w materiale torbieli naskórkowej pochodzi ze ściany torbieli i często jest ułożona w strukturę laminowaną. W badaniach obrazowych obwodowa struktura wyściełająca torbiel o niskiej intensywności sygnału w obrazach T2-zależnych była obserwowana w 76% przypadków. Obwodowa wyściółka była wyraźnie widoczna z wysoką częstością pozytywną u pacjentów z torbielami w kategorii dużych rozmiarów, podczas gdy tylko połowa przypadków z torbielami małymi prezentowała ten objaw.40

Różnice histopatologiczne między rodzajami torbieli

Torbiele naskórkowe są czasami nazywane torbielami łojowymi. Określenie to nie jest prawidłowe, ponieważ zawartość tych dwóch rodzajów torbieli jest różna. Torbiele naskórkowe są wypełnione martwymi komórkami skóry, podczas gdy prawdziwe torbiele łojowe są wypełnione żółtawym oleistym materiałem.4142

Badania z użyciem przeciwciał monoklonalnych przeciwko białkom cytokeratynowym (CK) wykazały, że CK 10 i 11 znajdują się w warstwach nadpodstawnych nabłonka wielowarstwowego płaskiego, podczas gdy barwienie dla CK 13 było ogniskowe lub rozlane. CK 18 i 19 dekorowały pojedyncze komórki płaskie lub barwiły całą grubość nabłonka.43

Czynniki ryzyka i lokalizacja torbieli naskórkowych

Znane czynniki ryzyka rozwoju torbieli naskórkowych są związane ze stanem zapalnym i podrażnieniem, w tym z przewlekłym uszkodzeniem słonecznym i trądzikiem pospolitym.44 Większość przypadków jest sporadyczna i wynika ze stanu zapalnego i podrażnienia, które powodują zablokowanie lejka i utworzenie torbieli wypełnionej keratyną.45

Torbiele naskórkowe najczęściej występują na:

  • Twarzy
  • Szyi
  • Tułowiu
  • Plecach
  • Rzadziej na dłoniach, podeszwach stóp i narządach płciowych

4647

W przypadku skóry nieowłosionej, takiej jak pośladki, dłonie lub podeszwy stóp, torbiel naskórkowa może być spowodowana urazową implantacją komórek naskórkowych do skóry właściwej, gdzie keratyna gromadzi się w worku wyścielonym nabłonkiem.48

Mechanizm wzrostu i objawy kliniczne

Torbiele naskórkowe powstają, gdy komórki naskórkowe przemieszczają się głębiej w skórę, zamiast złuszczać się. Czasami ten rodzaj torbieli tworzy się z powodu podrażnienia lub urazu skóry lub mieszka włosowego.49 Komórki naskórkowe tworzą ściany torbieli, a następnie wydzielają do niej białko keratynę. Keratyna to gęsta, serowata substancja, która może wyciekać z torbieli.50

Klinicznie torbiele naskórkowe prezentują się jako dobrze odgraniczone, skórnie lub żółtawo zabarwione guzki podskórne lub skórne z punktem w środku zmiany, które mogą występować w dowolnym miejscu na ciele.51 Średnica torbieli naskórkowych waha się od kilku milimetrów do 5 cm. Olbrzymia torbiel naskórkowa jest definiowana jako torbiel o średnicy przekraczającej 5 cm i często występuje w okolicy pośladkowej i moszny.52

Torbiele są zazwyczaj bezobjawowe, dopóki nie pękną lub nie ulegną zakażeniu. Mechanizm wzrostu torbieli polega na proliferacji komórek naskórkowych w obrębie skóry właściwej, gdzie dochodzi do akumulacji keratyny i resztek komórkowych wewnątrz worka torbieli, prowadząc do poszerzenia torbieli.53

Powikłania i leczenie torbieli naskórkowych

Torbiele naskórkowe są zwykle łagodne i wolno rosnące, rzadko ulegają transformacji złośliwej.54 Jednak mogą stać się zakażone i tworzyć bolesne ropnie. Mogą nawracać, jeśli nie zostaną całkowicie usunięte chirurgicznie.55

Najskuteczniejszym leczeniem torbieli naskórkowej jest całkowite chirurgiczne wycięcie z nienaruszonym torebką torbieli. Usunięcie całej wyściółki torbieli zmniejsza częstość nawrotów.56 W przypadku torbieli zapalnych skuteczne jest nacięcie i drenaż torbieli; nie ma dowodów potwierdzających stosowanie antybiotyków ogólnoustrojowych.57

Nowe podejścia terapeutyczne obejmują stosowanie enzymów hydrolitycznych, takich jak hialuronidaza, kolagenaza i lipaza, jako mniej inwazyjnego rozwiązania. Enzymy te celują w rozkład kluczowych składników wewnątrz torbieli, takich jak bogata w lipidy wydzielina łojowa i torebka kolagenowa, oferując strategię zmniejszenia bliznowacenia i skrócenia czasu rekonwalescencji, co jest szczególnie istotne w przypadku zabiegów na twarzy, gdzie kwestie estetyczne są najważniejsze.58

Istnieją również doniesienia o stosowaniu iniekcji fosfolipidów (fosfolipidocholiny) w leczeniu torbieli naskórkowych, chociaż farmakologia wstrzykiwanego PPC w tkance podskórnej nie została jeszcze wyjaśniona, a mechanizm miejscowej redukcji tłuszczu jest nieznany.59

Zalecenia dotyczące postępowania z torbielami naskórkowymi

Ze względu na ich łagodny, powolny charakter, bezobjawowe torbiele naskórkowe powinny być leczone zachowawczo. Wycięcie chirurgiczne jest niezbędne w przypadku zmian z progresją objawową i gdy obrazowanie pokazuje, że elementy nerwowe są uciśnięte.60

Radioterapia była stosowana w jednym przypadku z powtarzającymi się nawrotami torbieli naskórkowych, osiągając stosunkowo dobry wynik, jednak leczenie to powinno być stosowane tylko u pacjentów, którzy odmawiają operacji lub są niezdolni do operacji z powodów medycznych.61

Bez wątpienia całkowite wycięcie bez uszkodzenia nerwów jest celem leczenia. Całkowite wycięcie, które wymaga całkowitego usunięcia guza bez rozerwania torebki, jest doskonałą formą całkowitego wycięcia.62

Pomimo łagodnego charakteru torbieli naskórkowych, miejscowy nawrót nie jest rzadki po niekompletnym wycięciu chirurgicznym. Objawowe przypadki nawrotowe powinny być ponownie leczone chirurgicznie.63

Zaleca się, aby wszystkie zmiany, które przypuszczalnie są torbielami naskórkowymi, były całkowicie wycięte i przesłane w stanie nienaruszonym do szczegółowego badania histologicznego w celu wykluczenia złośliwej transformacji.64

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  1. 09.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts result from the proliferation of epidermal cells within a circumscribed space of the dermis. Analysis of their lipid pattern demonstrates similarities to the epidermis. In addition, epidermoid cysts express cytokeratins 1 and 10, which are constituents of the suprabasilar layers of the epidermis. The source of this epidermis is nearly always the infundibulum of the hair follicle, as evidenced by the observation that the lining of the two structures is identical. […] Studies have suggested that human papillomavirus (HPV) and exposure to ultraviolet (UV) light may play a role in the formation of some epidermoid cysts, particularly verrucous cysts with coarse hypergranulosis. […] The manner in which carcinomas may arise within epidermoid cysts is unclear. In a series of epidermoid cysts with carcinoma, immunohistochemical results for HPV were negative, suggesting that HPV is not likely to play a role in the development in squamous cell carcinoma (SCC) in epidermoid cysts. Chronic irritation or repetitive trauma to the epithelial lining of the cyst has been suggested to play a role in malignant transformation; however, this relation has not been established.
  • #2 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.
  • #3 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts result from the proliferation of epidermal cells within a circumscribed space of the dermis. Analysis of their lipid pattern demonstrates similarities to the epidermis. In addition, epidermoid cysts express cytokeratins 1 and 10, which are constituents of the suprabasilar layers of the epidermis. The source of this epidermis is nearly always the infundibulum of the hair follicle, as evidenced by the observation that the lining of the two structures is identical. […] Studies have suggested that human papillomavirus (HPV) and exposure to ultraviolet (UV) light may play a role in the formation of some epidermoid cysts, particularly verrucous cysts with coarse hypergranulosis. […] The manner in which carcinomas may arise within epidermoid cysts is unclear. In a series of epidermoid cysts with carcinoma, immunohistochemical results for HPV were negative, suggesting that HPV is not likely to play a role in the development in squamous cell carcinoma (SCC) in epidermoid cysts. Chronic irritation or repetitive trauma to the epithelial lining of the cyst has been suggested to play a role in malignant transformation; however, this relation has not been established.
  • #4 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.
  • #5 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.
  • #6 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.
  • #7 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts likely form via several mechanisms. They may result from the sequestration of epidermal rests during embryonic life, occlusion of the pilosebaceous unit, or traumatic or surgical implantation of epithelial elements. HPV infection, UV light exposure, and eccrine duct occlusion may be additional factors in the development of palmoplantar epidermoid cysts. […] True epidermal inclusion cysts result from the implantation of epithelial elements in the dermis. Certain injuries, especially of the crushing type, have been associated with subungual or terminal phalanx epidermoid cysts. A crush injury sustained from slamming a car door on a digit is frequently reported. Any surgical procedure can theoretically result in epidermoid cysts. The formation of multiple epidermoid cysts after rhinoplasty, breast augmentation, and liposuction has been described. […] Certain hereditary syndromes are associated with epidermoid cysts. Such syndromes include Gardner syndrome, basal cell nevus syndrome, and pachyonychia congenita.
  • #8 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts likely form via several mechanisms. They may result from the sequestration of epidermal rests during embryonic life, occlusion of the pilosebaceous unit, or traumatic or surgical implantation of epithelial elements. HPV infection, UV light exposure, and eccrine duct occlusion may be additional factors in the development of palmoplantar epidermoid cysts. […] True epidermal inclusion cysts result from the implantation of epithelial elements in the dermis. Certain injuries, especially of the crushing type, have been associated with subungual or terminal phalanx epidermoid cysts. A crush injury sustained from slamming a car door on a digit is frequently reported. Any surgical procedure can theoretically result in epidermoid cysts. The formation of multiple epidermoid cysts after rhinoplasty, breast augmentation, and liposuction has been described. […] Certain hereditary syndromes are associated with epidermoid cysts. Such syndromes include Gardner syndrome, basal cell nevus syndrome, and pachyonychia congenita.
  • #9 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts likely form via several mechanisms. They may result from the sequestration of epidermal rests during embryonic life, occlusion of the pilosebaceous unit, or traumatic or surgical implantation of epithelial elements. HPV infection, UV light exposure, and eccrine duct occlusion may be additional factors in the development of palmoplantar epidermoid cysts. […] True epidermal inclusion cysts result from the implantation of epithelial elements in the dermis. Certain injuries, especially of the crushing type, have been associated with subungual or terminal phalanx epidermoid cysts. A crush injury sustained from slamming a car door on a digit is frequently reported. Any surgical procedure can theoretically result in epidermoid cysts. The formation of multiple epidermoid cysts after rhinoplasty, breast augmentation, and liposuction has been described. […] Certain hereditary syndromes are associated with epidermoid cysts. Such syndromes include Gardner syndrome, basal cell nevus syndrome, and pachyonychia congenita.
  • #10 Epidermoid Cyst of the Sole: A report of two cases positive for human papillomavirus.
    http://jpatholtm.org/journal/view.php?number=2042
    Epidermoid cysts occur rarely on the palms and soles, where hair is not present. Te cysts have long been assumed to arise from traumatic implantation of epidermal fragment, but the pathogenesis is still controversial. […] Recently, with microscopic findings, immunohistochemical features, and molecular studies, the epidermoid cysts of the sole may be induced by the human papillomavirus. We report two cases of epidermoid cysts of the sole with the discussion of the pathogenesis.
  • #11 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts likely form via several mechanisms. They may result from the sequestration of epidermal rests during embryonic life, occlusion of the pilosebaceous unit, or traumatic or surgical implantation of epithelial elements. HPV infection, UV light exposure, and eccrine duct occlusion may be additional factors in the development of palmoplantar epidermoid cysts. […] True epidermal inclusion cysts result from the implantation of epithelial elements in the dermis. Certain injuries, especially of the crushing type, have been associated with subungual or terminal phalanx epidermoid cysts. A crush injury sustained from slamming a car door on a digit is frequently reported. Any surgical procedure can theoretically result in epidermoid cysts. The formation of multiple epidermoid cysts after rhinoplasty, breast augmentation, and liposuction has been described. […] Certain hereditary syndromes are associated with epidermoid cysts. Such syndromes include Gardner syndrome, basal cell nevus syndrome, and pachyonychia congenita.
  • #12 Correlation of radiological features of white epidermoid cysts with histopathological findings | Scientific Reports
    https://www.nature.com/articles/s41598-022-06167-x
    Epidermoid cysts are benign congenital lesions that arise from retained ectodermal epithelium during neural tube closure between the third and fifth weeks of gestation. They represent about 0.2-1.8% of all primary intracranial tumors. Although typically congenital, epidermoid cysts can be acquired following surgery or trauma. […] The cause of this hyperintensity is not clearly understood, but the presence of cholesterol, microcalcifications, proteinaceous content and rarely hemorrhage or melanin may be contributing factors. […] The underlying etiology remains not clearly understood. Braun et al. attributed the high attenuation of dense epidermoid cysts on CT scan to diffuse calcifications and saponification of internal debris. Other authors believe the dense aspect of the epidermoid is related to diffuse calcifications and ossifications of the thickened capsule and high protein content of the cystic fluid due to a proliferative and exudative defense reaction secondary to minor leak of the lepidic material through the cyst capsule, which probably explains the T1 hyperintensity in only one of our cases. […] Three of our cases had cholesterol clefts, which may possibly be the cause of T1 hyperintensity. Although chemical analysis was not performed in any of our cases, it has been reported that cholesterol in concentrations less than about 7 mmol/L would not account for T1 hyperintensity of cyst fluid.
  • #13 Cecal epidermoid cyst: a neonatal case with clinicopathological consideration | BMC Pediatrics | Full Text
    https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02884-w
    Two pathogenic mechanisms have been proposed for congenital sequestration. One mechanism suggests that ectodermal implantation occurs at the time of neural groove closure during embryogenesis; however, some researchers have postulated that given the location of the cecum and the neural groove or other epithelial fusion lines, this mechanism would be unusual. Another mechanism is that the origin of the congenital heterotopic tissue may have transpired during the intrauterine rotation of the gut back into the abdominal cavity, especially since the cecum is one of the last elements to re-enter the abdomen. Furthermore, the fact that most CECs occur in the subserosal layer supports this mechanism. […] In the present case of congenital CEC, heterotopic epithelial tissue was located in the subserosal layer, which is suggestive of ectodermal implantation during intrauterine rotation of the gut. Additionally, mucin-producing ciliated stratified epithelium was identified in this case and this epithelium resembled a bronchial epithelium. This finding could suggest a possible pathomechanism which may be related to the bi-differentiation of heterotopic ectodermal inclusion tissue.
  • #14 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.
  • #15 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts result from the proliferation of epidermal cells within a circumscribed space of the dermis. Analysis of their lipid pattern demonstrates similarities to the epidermis. In addition, epidermoid cysts express cytokeratins 1 and 10, which are constituents of the suprabasilar layers of the epidermis. The source of this epidermis is nearly always the infundibulum of the hair follicle, as evidenced by the observation that the lining of the two structures is identical. […] Studies have suggested that human papillomavirus (HPV) and exposure to ultraviolet (UV) light may play a role in the formation of some epidermoid cysts, particularly verrucous cysts with coarse hypergranulosis. […] The manner in which carcinomas may arise within epidermoid cysts is unclear. In a series of epidermoid cysts with carcinoma, immunohistochemical results for HPV were negative, suggesting that HPV is not likely to play a role in the development in squamous cell carcinoma (SCC) in epidermoid cysts. Chronic irritation or repetitive trauma to the epithelial lining of the cyst has been suggested to play a role in malignant transformation; however, this relation has not been established.
  • #16 Gigantic occipital epidermal cyst in a 56-year-old female: A case report
    https://www.wjgnet.com/2307-8960/full/v12/i6/1169.htm
    Several other studies have shown evidence of human papilloma virus (HPV) infection in epidermal cysts in the palm and plantar parts and limbs, especially in patients infected with HPV type 57, which further suggests that HPV infection may be related to the pathogenesis of epidermal cysts. […] In addition, some scholars have found that plantar epidermal cysts are attached to or located near exocrine ducts, suggesting that epidermal cysts may originate from exocrine ducts. […] Moreover, an HPV 60-associated epidermoid cyst with immunoreactivities for carcinoembryonic antigen, involucrin and CKs identical to those of the epidermis connected with the eccrine dermal duct was found, suggesting that certain palmoplantar epidermoid cysts may develop following the epidermoid metaplasia of eccrine ducts with HPV 60 infection. […] In conclusion, the pathogenesis of epidermal cysts is still unclear and controversial.
  • #17 Gigantic occipital epidermal cyst in a 56-year-old female: A case report
    https://www.wjgnet.com/2307-8960/full/v12/i6/1169.htm
    Several other studies have shown evidence of human papilloma virus (HPV) infection in epidermal cysts in the palm and plantar parts and limbs, especially in patients infected with HPV type 57, which further suggests that HPV infection may be related to the pathogenesis of epidermal cysts. […] In addition, some scholars have found that plantar epidermal cysts are attached to or located near exocrine ducts, suggesting that epidermal cysts may originate from exocrine ducts. […] Moreover, an HPV 60-associated epidermoid cyst with immunoreactivities for carcinoembryonic antigen, involucrin and CKs identical to those of the epidermis connected with the eccrine dermal duct was found, suggesting that certain palmoplantar epidermoid cysts may develop following the epidermoid metaplasia of eccrine ducts with HPV 60 infection. […] In conclusion, the pathogenesis of epidermal cysts is still unclear and controversial.
  • #18 Bacteriology of Epidermoid Cystslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
    https://www.jwatch.org/jd199803010000002/1998/03/01/bacteriology-epidermoid-cysts
    When epidermal inclusion (epidermoid) cysts become inflamed, many clinicians assume that infection has occurred, and they not only incise and drain the lesion but also prescribe systemic antibiotics. The evidence for this assumption is sparse. […] This report demonstrates that bacterial colonization of inflamed and uninflamed epidermoid cysts is common. Because neither the number nor type of organisms changes during inflammation, a cause other than infection is probably responsible for the inflammation. The authors hypothesize that the wall of the cyst may rupture, extruding its contents into the dermis. […] Regardless of the mechanism, incision and drainage of the cyst should suffice; no evidence supports the use of systemic antibiotics.
  • #19 Bacteriology of Epidermoid Cystslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
    https://www.jwatch.org/jd199803010000002/1998/03/01/bacteriology-epidermoid-cysts
    When epidermal inclusion (epidermoid) cysts become inflamed, many clinicians assume that infection has occurred, and they not only incise and drain the lesion but also prescribe systemic antibiotics. The evidence for this assumption is sparse. […] This report demonstrates that bacterial colonization of inflamed and uninflamed epidermoid cysts is common. Because neither the number nor type of organisms changes during inflammation, a cause other than infection is probably responsible for the inflammation. The authors hypothesize that the wall of the cyst may rupture, extruding its contents into the dermis. […] Regardless of the mechanism, incision and drainage of the cyst should suffice; no evidence supports the use of systemic antibiotics.
  • #20 Bacteriological Study of Epidermal Cysts | HTML | Acta Dermato-Venereologica
    https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0348
    Epidermal cysts are closed sacs with a definite wall that results from proliferation of surface epidermal cells. Production of keratin and lack of communication with the surface are responsible for cyst formation. […] It is a matter of debate whether bacterial infection plays a role in the inflammatory process. […] This inflammatory process may not be a simple bacterial skin infection; however, micro-organisms may have some influence on the inflammation mechanism of epidermal cysts. […] This study highlights the predominance of anaerobes in inflamed epidermal cysts, strongly suggesting that anaerobic bacterial infection may play a significant role in the inflammatory process.
  • #21 Bacteriological Study of Epidermal Cysts | HTML | Acta Dermato-Venereologica
    https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0348
    Epidermal cysts are closed sacs with a definite wall that results from proliferation of surface epidermal cells. Production of keratin and lack of communication with the surface are responsible for cyst formation. […] It is a matter of debate whether bacterial infection plays a role in the inflammatory process. […] This inflammatory process may not be a simple bacterial skin infection; however, micro-organisms may have some influence on the inflammation mechanism of epidermal cysts. […] This study highlights the predominance of anaerobes in inflamed epidermal cysts, strongly suggesting that anaerobic bacterial infection may play a significant role in the inflammatory process.
  • #22 KoreaMed Synapse
    https://synapse.koreamed.org/articles/1516080443
    Malignant transformation of epidermoid cysts is extremely rare (1%). […] Although the precise mechanism remains unclear, the involvement of chronic inflammation due to remnant cystic components, especially in long-standing lesions, has been suggested to be involved in the general etiology of squamous cell carcinogenesis.
  • #23 KoreaMed Synapse
    https://synapse.koreamed.org/articles/1516080443
    Malignant transformation of epidermoid cysts is extremely rare (1%). […] Although the precise mechanism remains unclear, the involvement of chronic inflammation due to remnant cystic components, especially in long-standing lesions, has been suggested to be involved in the general etiology of squamous cell carcinogenesis.
  • #24 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts result from the proliferation of epidermal cells within a circumscribed space of the dermis. Analysis of their lipid pattern demonstrates similarities to the epidermis. In addition, epidermoid cysts express cytokeratins 1 and 10, which are constituents of the suprabasilar layers of the epidermis. The source of this epidermis is nearly always the infundibulum of the hair follicle, as evidenced by the observation that the lining of the two structures is identical. […] Studies have suggested that human papillomavirus (HPV) and exposure to ultraviolet (UV) light may play a role in the formation of some epidermoid cysts, particularly verrucous cysts with coarse hypergranulosis. […] The manner in which carcinomas may arise within epidermoid cysts is unclear. In a series of epidermoid cysts with carcinoma, immunohistochemical results for HPV were negative, suggesting that HPV is not likely to play a role in the development in squamous cell carcinoma (SCC) in epidermoid cysts. Chronic irritation or repetitive trauma to the epithelial lining of the cyst has been suggested to play a role in malignant transformation; however, this relation has not been established.
  • #25 Malignant Transformation in a Typical Epidermal Cutaneous Cyst | Anastasios | Journal of Medical Cases
    https://www.journalmc.org/index.php/JMC/article/view/626/386
    Although cutaneous epidermal cysts are very common, malignant transformation is a rare event. […] The clinical and histological characteristics together with the differential diagnosis and the pathogenesis of this unexpected development are discussed. […] Epidermal cysts are usually located in the mid and lower dermis. They are lined by stratified squamous epithelium showing epidermal keratinisation in a flattened surface epithelium. As such, they are thought to be derived from, or mimic to, the infundibular portion of the hair follicle. […] Malignant transformation of these cysts are known to occur, although only rarely and includes basal and squamous cell carcinoma, Pagets disease, Bowens disease, mycosis fungoides, Merkel cell carcinoma and malignant melanoma. […] With regard to the pathogenesis, exposure of the skin to ultra-violet radiation is the most common cause for the development of squamous cell carcinoma. […] Squamous-cell carcinoma is more likely to develop in an injured or chronically diseased skin. […] It is, therefore, recommended that all lesions presumed to be epidermal cysts should be completely excised and submitted intact for a detailed histological examination.
  • #26 Abdominal giant epidermoid cyst with squamous epithelial heterogeneous proliferation carcinoma in part of the cyst wall: a case report – Hu – Translational Cancer Research
    https://tcr.amegroups.org/article/view/64721/html
    Epidermoid cysts, which are rarely malignant, are common skin cysts. […] The current pathogenesis of epidermoid cysts is unclear, which is attributable to the following reasons: (I) Epidermoid cysts originate from the funnels of hair follicles. Moreover, they are caused by progressive cystic expansion and destruction of the funnels of hair follicles. […] Some studies suggest that HPV (human papillomavirus) infection may be associated with the paroxysm of epidermal cysts, especially HPV types 57 and 60. […] Other studies suggest that ectodermal cells migrate abnormally during embryonic development, which allows them to enter the ectodermal tissue in other tissues and continue to develop without degeneration leading to cyst formation. […] A number of experts believe that some patients with epidermoid cysts have sustained irritation to the tissue at the cyst wall incision due to the epidermoid cyst contents postoperatively, resulting in chronic inflammatory responses that dephosphorylate the thin layer of the squamous epithelium, eventually leading to a malignant transformation of the epidermoid cyst and a formation of squamous carcinoma.
  • #27 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    The majority of cases are of epidermoid cysts are sporadic. Although epidermoid cysts can be found in autosomal dominant (AD) Gardner syndrome (familial adenomatous polyposis) and Gorlin syndrome (basal cell nevus syndrome). Epidermoid cysts occurring before puberty in unusual locations and numbers raise the suspicion of a syndrome. In Favre-Racouchot syndrome (nodular elastosis with cysts and comedones) in elderly patients, epidermoid cysts may result from chronic sun damage. Patients on BRAF inhibitors can develop epidermoid cysts of the face. Lately, imiquimod and cyclosporine have been noted to cause epidermal inclusion cysts.
  • #28 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    The majority of cases are of epidermoid cysts are sporadic. Although epidermoid cysts can be found in autosomal dominant (AD) Gardner syndrome (familial adenomatous polyposis) and Gorlin syndrome (basal cell nevus syndrome). Epidermoid cysts occurring before puberty in unusual locations and numbers raise the suspicion of a syndrome. In Favre-Racouchot syndrome (nodular elastosis with cysts and comedones) in elderly patients, epidermoid cysts may result from chronic sun damage. Patients on BRAF inhibitors can develop epidermoid cysts of the face. Lately, imiquimod and cyclosporine have been noted to cause epidermal inclusion cysts.
  • #29 Epidermoid Cyst: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/1061582-questions-and-answers
    Epidermoid cysts likely form via several mechanisms. They may result from the sequestration of epidermal rests during embryonic life, occlusion of the pilosebaceous unit, or traumatic or surgical implantation of epithelial elements. HPV infection, UV light exposure, and eccrine duct occlusion may be additional factors in the development of palmoplantar epidermoid cysts. […] True epidermal inclusion cysts result from the implantation of epithelial elements in the dermis. Certain injuries, especially of the crushing type, have been associated with subungual or terminal phalanx epidermoid cysts. A crush injury sustained from slamming a car door on a digit is frequently reported. Any surgical procedure can theoretically result in epidermoid cysts. The formation of multiple epidermoid cysts after rhinoplasty, breast augmentation, and liposuction has been described. […] Certain hereditary syndromes are associated with epidermoid cysts. Such syndromes include Gardner syndrome, basal cell nevus syndrome, and pachyonychia congenita.
  • #30 Open Access Macedonian Journal of Medical Sciences (OAMJMS).
    https://oamjms.eu/index.php/mjms/article/view/oamjms.2018.027
    Epidermoid cysts are common benign lesions of hair-bearing, and less often glabrous skin. […] Diagnosis of epidermoid cysts needs histopathological confirmation not only of the potential of malignant transformation. […] Rare genetic disorders with multiple cysts are Gardner and Lowe syndrome. […] Pathogenesis of plantar epidermal cyst: Three-dimensional reconstruction analysis. […] Human papillomavirus-associated plantar epidermoid cyst related to epidermoid metaplasia of the eccrine duct epithelium: a combined histological, immunohistochemical, DNA-DNA in situ hybridization and three-dimensional reconstruction analysis. […] Gardner syndrome associated with multiple osteomas, intestinal polyposis, and epidermoid cysts. […] Multiple protrusive epidermal cysts on the scalp of a Lowe syndrome patient.
  • #31 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    The majority of cases are of epidermoid cysts are sporadic. Although epidermoid cysts can be found in autosomal dominant (AD) Gardner syndrome (familial adenomatous polyposis) and Gorlin syndrome (basal cell nevus syndrome). Epidermoid cysts occurring before puberty in unusual locations and numbers raise the suspicion of a syndrome. In Favre-Racouchot syndrome (nodular elastosis with cysts and comedones) in elderly patients, epidermoid cysts may result from chronic sun damage. Patients on BRAF inhibitors can develop epidermoid cysts of the face. Lately, imiquimod and cyclosporine have been noted to cause epidermal inclusion cysts.
  • #32 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    The majority of cases are of epidermoid cysts are sporadic. Although epidermoid cysts can be found in autosomal dominant (AD) Gardner syndrome (familial adenomatous polyposis) and Gorlin syndrome (basal cell nevus syndrome). Epidermoid cysts occurring before puberty in unusual locations and numbers raise the suspicion of a syndrome. In Favre-Racouchot syndrome (nodular elastosis with cysts and comedones) in elderly patients, epidermoid cysts may result from chronic sun damage. Patients on BRAF inhibitors can develop epidermoid cysts of the face. Lately, imiquimod and cyclosporine have been noted to cause epidermal inclusion cysts.
  • #33 Whole Exome Sequencing of Intracranial Epidermoid Cysts Reveals Immune-Associated Mechanistic and Potential Targets
    https://www.mdpi.com/2072-6694/16/20/3487
    The pathway enrichment indicated involvement in antigen processing and presentation, ECM-receptor, focal adhesion, as well as PI3K-Akt-mTOR signaling. […] Given that the TME comprises blood vessels, extracellular matrix, stromal and immune cells, our results indicate that genetic alterations in immune, ECM-receptor and adhesion genes may have a role in shaping the TME of intracranial epidermoid cysts. […] IECs were characterized by an altered immune repertoire. […] The high mutation burden observed in HLA and KIR genes suggests that these genes may be involved in mechanisms of immune evasion in IECs. […] Together, these observations suggest that alteration in USP8 and NOTCH2 may result in downstream dysregulation of EGF receptor signaling in IECs. […] The high mutation burden observed in genes strongly suggests a potential interplay between PI3K-Akt-mTOR signaling and ECM, contributing to tumor cell function and the establishment of a tumor-supportive microenvironment in IECs.
  • #34 Whole Exome Sequencing of Intracranial Epidermoid Cysts Reveals Immune-Associated Mechanistic and Potential Targets
    https://www.mdpi.com/2072-6694/16/20/3487
    The pathway enrichment indicated involvement in antigen processing and presentation, ECM-receptor, focal adhesion, as well as PI3K-Akt-mTOR signaling. […] Given that the TME comprises blood vessels, extracellular matrix, stromal and immune cells, our results indicate that genetic alterations in immune, ECM-receptor and adhesion genes may have a role in shaping the TME of intracranial epidermoid cysts. […] IECs were characterized by an altered immune repertoire. […] The high mutation burden observed in HLA and KIR genes suggests that these genes may be involved in mechanisms of immune evasion in IECs. […] Together, these observations suggest that alteration in USP8 and NOTCH2 may result in downstream dysregulation of EGF receptor signaling in IECs. […] The high mutation burden observed in genes strongly suggests a potential interplay between PI3K-Akt-mTOR signaling and ECM, contributing to tumor cell function and the establishment of a tumor-supportive microenvironment in IECs.
  • #35 Epidermoid Cyst | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/28808
    Epidermoid cysts are derived from the follicular infundibulum. Generally, these cysts are the result of plugging of the follicular orifice. The cyst communicates with the surface of the skin through a keratin-filled orifice. Disruption of the follicle is important in the pathogenesis as those with acne vulgaris may have multiple epidermoid cysts originating from comedones. Additionally, they can also occur from traumatic and penetrate injuring leading to the implantation of the epithelium. Epidermoid cysts are lined with stratified squamous epithelium that leads to an accumulation of keratin within the subepidermal layer or dermis. Generally, the cysts are asymptomatic until they rupture. When the cysts rupture, an inflammatory reaction occurs from the displacement of soft and yellow keratin into the dermis and surrounding tissue. Recently ultraviolet (UV) light and infection with the human papillomavirus (HPV) have been implicated as causing epidermoid cysts.
  • #36 Malignant Transformation in a Typical Epidermal Cutaneous Cyst | Anastasios | Journal of Medical Cases
    https://www.journalmc.org/index.php/JMC/article/view/626/386
    Although cutaneous epidermal cysts are very common, malignant transformation is a rare event. […] The clinical and histological characteristics together with the differential diagnosis and the pathogenesis of this unexpected development are discussed. […] Epidermal cysts are usually located in the mid and lower dermis. They are lined by stratified squamous epithelium showing epidermal keratinisation in a flattened surface epithelium. As such, they are thought to be derived from, or mimic to, the infundibular portion of the hair follicle. […] Malignant transformation of these cysts are known to occur, although only rarely and includes basal and squamous cell carcinoma, Pagets disease, Bowens disease, mycosis fungoides, Merkel cell carcinoma and malignant melanoma. […] With regard to the pathogenesis, exposure of the skin to ultra-violet radiation is the most common cause for the development of squamous cell carcinoma. […] Squamous-cell carcinoma is more likely to develop in an injured or chronically diseased skin. […] It is, therefore, recommended that all lesions presumed to be epidermal cysts should be completely excised and submitted intact for a detailed histological examination.
  • #37 Pathology Outlines – Epidermoid / epidermal inclusion cyst
    https://www.pathologyoutlines.com/topic/skintumornonmelanocytickeratinouscystepidermal.html
    Epidermoid cysts arise as well demarcated dermal papules or nodules, often skin colored to yellow in appearance with a central punctum; they occur most commonly on the face and upper trunk […] Derived from the follicular infundibulum and result in a cystic cavity lined by a stratified squamous epithelium with lamellated keratin flakes in the cyst lumen […] Occurs spontaneously or from injury induced implantation of epithelium […] Results from occluded pilosebaceous units at the follicular orifice by bacteria and keratin […] Surface epidermal cells proliferate within the dermis […] Keratin and cell debris accumulate within the cyst sac, leading to cystic dilation […] Typically asymptomatic unless cyst ruptures […] Rarely, squamous cell carcinoma and basal cell carcinoma may arise from the cyst wall.
  • #38 An Unusual and Rare Case of Generalized Multiple Epidermoid Cysts with | IMCRJ
    https://www.dovepress.com/an-unusual-and-rare-case-of-generalized-multiple-epidermoid-cysts-with-peer-reviewed-fulltext-article-IMCRJ
    An EC may also arise from traumatic implantation of epidermal cells into the deeper layer ie, dermis, called inclusion cysts. […] In the dermis, epidermal cells can proliferate and collect debris and keratin, leading to formation of the cysts. […] In this report, multiple ECs on the right temple, chest, back, and gluteal regions could be caused by the keratin plugging the pilosebaceous unit which is similar to the pathogenesis of acne vulgaris. […] The diameter of ECs ranged from a few millimetres to 5 cm. […] A giant EC is defined as an EC with diameter exceeding 5 cm and are commonly found on the gluteal region and scrotum. […] The definite diagnosis of EC is established based on clinical and histopathological findings. […] The histopathological features of EC are cysts containing keratinous mass, which are lined by stratified squamous epithelia showing epidermal keratinization, formation of keratohyalin granules, and flattened surface epithelium. […] The result of histopathological examination of this patient revealed cysts coated by stratified squamous epithelia and containing keratinous mass which supported the diagnosis of EC.
  • #39
    https://austinpublishinggroup.com/surgery/fulltext/ajs-v5-id1120.php
    Epidermoid cysts resemble the common epidermal inclusion cyst of the skin. They are characterized by a squamous cell lining and produce keratin debris filling the lumen. […] The origin of these cysts has been theorized to be due to either aberrant ectoderm implantation during embryogenesis or traumatic metaplasia. According to some, the cyst originated from the embryonic remnant of Wolffian ducts and this hypothesis is considered the most acceptable. […] The typical pathological features are that the cyst is lined by stratified squamous epithelium with a granular layer and filled with keratinous material that is arranged in lamina.
  • #40 Characteristic MRI Findings of Epidermal Cysts Categorized by Size
    https://openorthopaedicsjournal.com/VOLUME/12/PAGE/462/FULLTEXT/
    The keratinous content in epidermal cyst material originates from the cyst wall and is often in a laminated arrangement. In our case series, the peripheral lining structure of the cyst has been emphasized. In a previous study, the peripheral lining structure with its low signal intensity on T2-weighted images was observed in 4 out of 9 cases (44%). In our cases in this study, a peripheral lining was observed 76% of the time. A peripheral lining was clearly evident at a high positive rate in patients with cysts in the large size category, while only half of the cases with small size cysts presented with this sign. A peripheral lining is a more reliable sign than intracyst debris when diagnosing small-sized epidermal cysts.
  • #41 Epidermoid cyst: MedlinePlus Medical EncyclopediaLock
    https://medlineplus.gov/ency/article/000842.htm
    Epidermoid cysts are very common. Their cause is unknown. The cysts are formed when elements of the surface skin get under the skin surface. The cyst then becomes filled with dead skin because as the skin grows, it can’t be shed as it can elsewhere on the body. […] Sometimes, epidermoid cysts are called sebaceous cysts. This is not correct because the contents of the two types of cysts are different. Epidermoid cysts are filled with dead skin cells, while true sebaceous cysts are filled with yellowish oily material. […] Epidermoid cysts may become infected and form painful abscesses. They may return if they are not completely removed by surgery.
  • #42 Sebaceous cyst – Wikipedia
    https://en.wikipedia.org/wiki/Sebaceous_cyst
    A sebaceous cyst is a term commonly used to refer to either: Epidermoid cysts (also termed epidermal cysts, infundibular cyst) […] Epidermoid cysts originate in the epidermis and pilar cysts originate from hair follicles. Technically speaking, then, they are not sebaceous cysts. […] Medical professionals have suggested that the term „sebaceous cyst” be avoided since it can be misleading.
  • #43
    https://link.springer.com/article/10.1007/BF00193502
    The stratified squamous epithelium of a splenic epidermoid cyst was studied with a battery of monoclonal antibodies to cytokeratin (CK) proteins. CKs 10 and 11 were found in the suprabasal layers of the stratified squamous epithelium, while staining for CK 13 was focal or diffuse throughout. CKs 18 and 19 decorated individual squamous cells or stained the entire thickness of the epithelium. These results were compared with those previously obtained by us in stratified squamous epithelia of ovarian mature cystic teratoma, fetal epidermis, adult epidermis and squamous metaplasia in a peritoneal cyst. From these comparisons it emerges that the epidermoid splenic cyst is either of teratomatous derivation or originates from inclusion of fetal squamous epithelium. Squamous metaplasia of mesothelium or inclusions of mature squamous epithelium appears to be an unlikely source of origin of these cysts.
  • #44 Epidermal Inclusion Cysts: Small, Asymptomatic Nodules on the Trunk – Dermatology Advisor
    https://www.dermatologyadvisor.com/ddi/epidermal-inclusion-cysts/
    Epidermal inclusion cysts result from inflammation and irritation that cause blockage of the infundibulum. This blockage results in epidermal proliferation and the formation of a keratin-filled cyst. […] Currently, the mechanism of neoplastic progression is unknown, but it is hypothesized that chronic irritation plays a central role. […] Known risk factors for the development of epidermal inclusion cysts are those associated with inflammation and irritation, including chronic sun damage and acne vulgaris. […] Most cases are sporadic and result from inflammation and irritation that causes blockage of the infundibulum and formation of keratin-filled cyst; generally benign, but rarely contain squamous cell carcinoma or basal cell carcinoma.
  • #45 Epidermal Inclusion Cysts: Small, Asymptomatic Nodules on the Trunk – Dermatology Advisor
    https://www.dermatologyadvisor.com/ddi/epidermal-inclusion-cysts/
    Epidermal inclusion cysts result from inflammation and irritation that cause blockage of the infundibulum. This blockage results in epidermal proliferation and the formation of a keratin-filled cyst. […] Currently, the mechanism of neoplastic progression is unknown, but it is hypothesized that chronic irritation plays a central role. […] Known risk factors for the development of epidermal inclusion cysts are those associated with inflammation and irritation, including chronic sun damage and acne vulgaris. […] Most cases are sporadic and result from inflammation and irritation that causes blockage of the infundibulum and formation of keratin-filled cyst; generally benign, but rarely contain squamous cell carcinoma or basal cell carcinoma.
  • #46 Epidermoid cysts – Symptoms and causes – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/epidermoid-cysts/symptoms-causes/syc-20352701
    Epidermoid cysts occur most often on the face, neck and trunk. […] Most epidermoid cysts form when these cells move deeper into the skin rather than shed. Sometimes this type of cyst forms due to irritation or injury of the skin or a hair follicle. […] Epidermal cells form the walls of the cyst and then secrete the protein keratin into it. Keratin is the thick, cheesy substance that can leak from the cyst.
  • #47 Pathology Outlines – Epidermoid / epidermal inclusion cyst
    https://www.pathologyoutlines.com/topic/skintumornonmelanocytickeratinouscystepidermal.html
    Epidermoid cysts arise as well demarcated dermal papules or nodules, often skin colored to yellow in appearance with a central punctum; they occur most commonly on the face and upper trunk […] Derived from the follicular infundibulum and result in a cystic cavity lined by a stratified squamous epithelium with lamellated keratin flakes in the cyst lumen […] Occurs spontaneously or from injury induced implantation of epithelium […] Results from occluded pilosebaceous units at the follicular orifice by bacteria and keratin […] Surface epidermal cells proliferate within the dermis […] Keratin and cell debris accumulate within the cyst sac, leading to cystic dilation […] Typically asymptomatic unless cyst ruptures […] Rarely, squamous cell carcinoma and basal cell carcinoma may arise from the cyst wall.
  • #48 Epidermoid cyst
    https://dermnetnz.org/topics/epidermoid-cyst
    An epidermoid cyst generally results from an occluded pilosebaceous unit. […] On non-hair-bearing areas of the body, such as the buttock, palm of the hand, or sole of the foot, an epidermoid cyst may be due to traumatic implantation of epidermal cells into the dermis where keratin accumulates within an epithelium-lined sac. […] The most effective treatment for an epidermoid cyst is complete surgical excision with an intact cyst capsule. Removal of the entire cyst lining decreases rates of recurrence. […] Epidermoid cysts are typically benign and slow growing, rarely undergoing malignant transformation.
  • #49 Epidermoid cysts – Symptoms and causes – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/epidermoid-cysts/symptoms-causes/syc-20352701
    Epidermoid cysts occur most often on the face, neck and trunk. […] Most epidermoid cysts form when these cells move deeper into the skin rather than shed. Sometimes this type of cyst forms due to irritation or injury of the skin or a hair follicle. […] Epidermal cells form the walls of the cyst and then secrete the protein keratin into it. Keratin is the thick, cheesy substance that can leak from the cyst.
  • #50 Epidermoid cysts – Symptoms and causes – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/epidermoid-cysts/symptoms-causes/syc-20352701
    Epidermoid cysts occur most often on the face, neck and trunk. […] Most epidermoid cysts form when these cells move deeper into the skin rather than shed. Sometimes this type of cyst forms due to irritation or injury of the skin or a hair follicle. […] Epidermal cells form the walls of the cyst and then secrete the protein keratin into it. Keratin is the thick, cheesy substance that can leak from the cyst.
  • #51 An Unusual and Rare Case of Generalized Multiple Epidermoid Cysts with | IMCRJ
    https://www.dovepress.com/an-unusual-and-rare-case-of-generalized-multiple-epidermoid-cysts-with-peer-reviewed-fulltext-article-IMCRJ
    Epidermoid cyst (EC) is a cyst containing keratin and its breakdown products, that is surrounded by an epidermoid wall. […] The clinical features of EC include asymptomatic, well-demarcated, and skin-colored to yellowish subcutaneous or dermal nodules with a punctum on the middle of the lesion which can occur anywhere on the body. […] Epidermoid cyst commonly results from plugged pilosebaceous units lined by a wall of epithelia resembling the infundibulum of hair follicle, and expresses the same cytokeratin profile. […] Thus, EC is thought to be derived from this structure. […] Multiple ECs originate from comedones that can be seen in patients with acne vulgaris or with significant history of acne vulgaris. […] Therefore, disruption of the hair follicle plays an important role in the pathogenesis of acne vulgaris.
  • #52 An Unusual and Rare Case of Generalized Multiple Epidermoid Cysts with | IMCRJ
    https://www.dovepress.com/an-unusual-and-rare-case-of-generalized-multiple-epidermoid-cysts-with-peer-reviewed-fulltext-article-IMCRJ
    An EC may also arise from traumatic implantation of epidermal cells into the deeper layer ie, dermis, called inclusion cysts. […] In the dermis, epidermal cells can proliferate and collect debris and keratin, leading to formation of the cysts. […] In this report, multiple ECs on the right temple, chest, back, and gluteal regions could be caused by the keratin plugging the pilosebaceous unit which is similar to the pathogenesis of acne vulgaris. […] The diameter of ECs ranged from a few millimetres to 5 cm. […] A giant EC is defined as an EC with diameter exceeding 5 cm and are commonly found on the gluteal region and scrotum. […] The definite diagnosis of EC is established based on clinical and histopathological findings. […] The histopathological features of EC are cysts containing keratinous mass, which are lined by stratified squamous epithelia showing epidermal keratinization, formation of keratohyalin granules, and flattened surface epithelium. […] The result of histopathological examination of this patient revealed cysts coated by stratified squamous epithelia and containing keratinous mass which supported the diagnosis of EC.
  • #53 Pathology Outlines – Epidermoid / epidermal inclusion cyst
    https://www.pathologyoutlines.com/topic/skintumornonmelanocytickeratinouscystepidermal.html
    Epidermoid cysts arise as well demarcated dermal papules or nodules, often skin colored to yellow in appearance with a central punctum; they occur most commonly on the face and upper trunk […] Derived from the follicular infundibulum and result in a cystic cavity lined by a stratified squamous epithelium with lamellated keratin flakes in the cyst lumen […] Occurs spontaneously or from injury induced implantation of epithelium […] Results from occluded pilosebaceous units at the follicular orifice by bacteria and keratin […] Surface epidermal cells proliferate within the dermis […] Keratin and cell debris accumulate within the cyst sac, leading to cystic dilation […] Typically asymptomatic unless cyst ruptures […] Rarely, squamous cell carcinoma and basal cell carcinoma may arise from the cyst wall.
  • #54 Epidermoid cyst
    https://dermnetnz.org/topics/epidermoid-cyst
    An epidermoid cyst generally results from an occluded pilosebaceous unit. […] On non-hair-bearing areas of the body, such as the buttock, palm of the hand, or sole of the foot, an epidermoid cyst may be due to traumatic implantation of epidermal cells into the dermis where keratin accumulates within an epithelium-lined sac. […] The most effective treatment for an epidermoid cyst is complete surgical excision with an intact cyst capsule. Removal of the entire cyst lining decreases rates of recurrence. […] Epidermoid cysts are typically benign and slow growing, rarely undergoing malignant transformation.
  • #55 Epidermoid cyst: MedlinePlus Medical EncyclopediaLock
    https://medlineplus.gov/ency/article/000842.htm
    Epidermoid cysts are very common. Their cause is unknown. The cysts are formed when elements of the surface skin get under the skin surface. The cyst then becomes filled with dead skin because as the skin grows, it can’t be shed as it can elsewhere on the body. […] Sometimes, epidermoid cysts are called sebaceous cysts. This is not correct because the contents of the two types of cysts are different. Epidermoid cysts are filled with dead skin cells, while true sebaceous cysts are filled with yellowish oily material. […] Epidermoid cysts may become infected and form painful abscesses. They may return if they are not completely removed by surgery.
  • #56 Epidermoid cyst
    https://dermnetnz.org/topics/epidermoid-cyst
    An epidermoid cyst generally results from an occluded pilosebaceous unit. […] On non-hair-bearing areas of the body, such as the buttock, palm of the hand, or sole of the foot, an epidermoid cyst may be due to traumatic implantation of epidermal cells into the dermis where keratin accumulates within an epithelium-lined sac. […] The most effective treatment for an epidermoid cyst is complete surgical excision with an intact cyst capsule. Removal of the entire cyst lining decreases rates of recurrence. […] Epidermoid cysts are typically benign and slow growing, rarely undergoing malignant transformation.
  • #57 Bacteriology of Epidermoid Cystslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
    https://www.jwatch.org/jd199803010000002/1998/03/01/bacteriology-epidermoid-cysts
    When epidermal inclusion (epidermoid) cysts become inflamed, many clinicians assume that infection has occurred, and they not only incise and drain the lesion but also prescribe systemic antibiotics. The evidence for this assumption is sparse. […] This report demonstrates that bacterial colonization of inflamed and uninflamed epidermoid cysts is common. Because neither the number nor type of organisms changes during inflammation, a cause other than infection is probably responsible for the inflammation. The authors hypothesize that the wall of the cyst may rupture, extruding its contents into the dermis. […] Regardless of the mechanism, incision and drainage of the cyst should suffice; no evidence supports the use of systemic antibiotics.
  • #58 Nonsurgical epidermoid cyst management, hydrolytic enzymes | CCID
    https://www.dovepress.com/successfully-nonsurgical-epidermoid-cyst-management-with-recombinant-h-peer-reviewed-fulltext-article-CCID
    A complementary enzyme, lipase, is known mostly for triacylglycerides hydrolysis and is used for targeting localised fat reduction, cellulite management, and enhancing both the face and body contours. […] The application of hydrolytic agents in the treatment of certain diseases needs more groundwork. […] This novel and straightforward technique offers a conservative approach, eliminating the risk of scarring sequelae. […] Proposing a departure from traditional surgical interventions, this discussion emphasises the potential of enzyme therapyutilising hyaluronidase, collagenase, and lipaseas a less invasive solution. These enzymes target the breakdown of key components within the cysts, such as the lipid-rich sebum and collagenous capsule, offering a strategy to diminish scarring and reduce recovery time, which is particularly crucial for facial treatments where aesthetic considerations are paramount.
  • #59 Epidermoid Cysts Treated With Phosphatidylcholine Injections
    https://www.patientcareonline.com/view/epidermoid-cysts-treated-phosphatidylcholine-injections
    Epidermoid cysts, also known as sebaceous or keratin cysts, are benign lesions that arise from ruptured pilosebaceous follicles that form dome-shaped keratin-filled sacs. […] The conventional and widely practiced method of treatment for epidermoid cysts is surgical removal. Complete excision is required to avoid recurrence. […] There is evidence that a rupture during excision increases the risk for infection and that recurrence rates are higher than those seen after successful removal. […] The pharmacology of injectable PPC in the subcutaneous tissue has not yet been explained, and the mechanism of localized fat reduction is unknown. […] Further studies are required to clarify the mechanism of action of subcutaneous PPC.
  • #60 Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine | World Journal of Surgical Oncology | Full Text
    https://wjso.biomedcentral.com/articles/10.1186/1477-7819-12-50
    Several theories have attempted to explain the pathogenesis of epidermal inclusion cysts. The classic, widely quoted theory set out by von Bostroem in 1897 expounded that those were developmental errors of the neural tube, occurring between the third and fifth week of embryonic life. […] The theory also considers that the timing of the event (early or late) determines the type of tumor (dermoid or epidermoid) that will form. […] In our series, the epidermoid cysts in all six patients were regarded as congenital because they had neither suffered trauma nor received a lumbar puncture. […] Given their indolent, benign nature, asymptomatic epidermoid cysts should be managed conservatively. Surgical excision is essential for lesions with symptomatic progression and where imaging shows that neural elements are compressed.
  • #61 Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine | World Journal of Surgical Oncology | Full Text
    https://wjso.biomedcentral.com/articles/10.1186/1477-7819-12-50
    Although radiotherapy has been used in one case with repeated relapses of epidermoid cysts, achieving a relatively good result, this treatment should only be used for patients who refuse surgery or are inoperable for medical reasons. […] Undoubtedly complete excision without neural damage is the goal of treatment. […] Total excision, which requires complete removal of the tumor without rupturing the capsule, is the perfect form of complete excision. […] In spite of the indolent, benign nature of epidermoid cysts, local recurrence is not uncommon after incomplete surgical excision. […] Symptomatic relapsed cases should be retreated by surgical excision. […] More research is needed to clarify the pathogenesis of epidermoid cysts, which will also aid treatment.
  • #62 Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine | World Journal of Surgical Oncology | Full Text
    https://wjso.biomedcentral.com/articles/10.1186/1477-7819-12-50
    Although radiotherapy has been used in one case with repeated relapses of epidermoid cysts, achieving a relatively good result, this treatment should only be used for patients who refuse surgery or are inoperable for medical reasons. […] Undoubtedly complete excision without neural damage is the goal of treatment. […] Total excision, which requires complete removal of the tumor without rupturing the capsule, is the perfect form of complete excision. […] In spite of the indolent, benign nature of epidermoid cysts, local recurrence is not uncommon after incomplete surgical excision. […] Symptomatic relapsed cases should be retreated by surgical excision. […] More research is needed to clarify the pathogenesis of epidermoid cysts, which will also aid treatment.
  • #63 Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine | World Journal of Surgical Oncology | Full Text
    https://wjso.biomedcentral.com/articles/10.1186/1477-7819-12-50
    Although radiotherapy has been used in one case with repeated relapses of epidermoid cysts, achieving a relatively good result, this treatment should only be used for patients who refuse surgery or are inoperable for medical reasons. […] Undoubtedly complete excision without neural damage is the goal of treatment. […] Total excision, which requires complete removal of the tumor without rupturing the capsule, is the perfect form of complete excision. […] In spite of the indolent, benign nature of epidermoid cysts, local recurrence is not uncommon after incomplete surgical excision. […] Symptomatic relapsed cases should be retreated by surgical excision. […] More research is needed to clarify the pathogenesis of epidermoid cysts, which will also aid treatment.
  • #64 Malignant Transformation in a Typical Epidermal Cutaneous Cyst | Anastasios | Journal of Medical Cases
    https://www.journalmc.org/index.php/JMC/article/view/626/386
    Although cutaneous epidermal cysts are very common, malignant transformation is a rare event. […] The clinical and histological characteristics together with the differential diagnosis and the pathogenesis of this unexpected development are discussed. […] Epidermal cysts are usually located in the mid and lower dermis. They are lined by stratified squamous epithelium showing epidermal keratinisation in a flattened surface epithelium. As such, they are thought to be derived from, or mimic to, the infundibular portion of the hair follicle. […] Malignant transformation of these cysts are known to occur, although only rarely and includes basal and squamous cell carcinoma, Pagets disease, Bowens disease, mycosis fungoides, Merkel cell carcinoma and malignant melanoma. […] With regard to the pathogenesis, exposure of the skin to ultra-violet radiation is the most common cause for the development of squamous cell carcinoma. […] Squamous-cell carcinoma is more likely to develop in an injured or chronically diseased skin. […] It is, therefore, recommended that all lesions presumed to be epidermal cysts should be completely excised and submitted intact for a detailed histological examination.

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