Atypical Presentation of Pilar Cyst Over the Volar Aspect of the Thumb: A Case Report and Review of Literature.

Pilar cysts are derived from the outer layer of the root sheath of hair follicles. They were conventionally thought to arise from hair-bearing skin like the scalp. However, this notion has been refuted recently. Pilar cysts of the hand are extremely rare, with only a few case reports in the literature. We report the case of a 40-year-old male patient, with no known medical co-morbidities, who presented with a swelling over his left thumb. It was occasionally painful, and caused difficulty in grasping objects. Physical examination revealed a 2.5 x 1.5 cm swelling over the volar aspect of the thumb, at the level of the proximal phalanx. MRI revealed the presence of a well-defined cystic lesion superficial to the flexor tendons. The possibility of an epidermal cyst was considered, and the patient was advised surgery in view of his symptoms and progression in the size of the swelling. He underwent excision of the lesion along with a segment of adherent skin. Histopathological examination of the lesion revealed the presence of a pilar cyst. The patient did not have recurrence of symptoms following surgery, and was found to be doing well at the three-year follow-up. This case report urges a re-thinking of the possible origins of pilar cysts from atypical locations.

Multiple Sebaceous Cysts on the Scrotum: A Rare Surgical Occurrence.

A sebaceous cyst is a benign encapsulated, subepidermal nodule filled with keratin material. They are mostly seen in areas with body hair such as the scalp, face, neck back, and scrotum. Having several sebaceous cysts on the scrotum is an uncommon occurrence, and if they become infected or look unsightly, they should be removed. Histologically, cysts are lined by stratified squamous epithelium and contain keratin debris and cholesterol. If the cysts are extremely swollen or infected, the entire scrotal wall must be removed, and the testicles should be covered. This is an unusual case where the patient had multiple painless nodules of varying sizes covering almost the entire scrotal skin. These were identified as sebaceous cysts and had been present for several months. All the cysts had to be removed in toto because of such an unusual presentation which was covering the entire scrotal skin.

Trends in Office Visits for the Five Most Common Skin Diseases in the United States.

Objective: We sought to determine the outpatient visit rates for the five most common skin conditions among dermatologists and non-dermatologists. Methods: We conducted a population-based, cross-sectional analysis using the National Ambulatory Medical Care Survey between 2007 and 2016, the most recent years available. Results: The five most common skin diagnoses among all medical specialties were contact dermatitis, acne vulgaris, actinic keratosis, benign neoplasm of the skin, and epidermoid cyst, respectively. Actinic keratosis followed by acne vulgaris and benign neoplasm of skin were the three most common visit diagnoses among dermatologists, whereas contact dermatitis, acne vulgaris, and epidermoid cyst were the most common among non-dermatologists. Overall, visits for the five most common skin conditions seen by dermatologists and non-dermatologists remained constant over the study interval. Limitations: Misclassification bias could be impacting the results of this study. Additionally, the NAMCS samples only non-hospital based outpatient clinicians, and thus cannot describe hospital-based outpatient visits or inpatient hospital care. Conclusion: Visits for contact dermatitis, acne, actinic keratosis, benign neoplasm of the skin, and epidermoid cysts have remained constant over the last ten years. These conditions represent the most common diagnoses of the skin at both dermatologists and non-dermatologists outpatient visits. Non-dermatologists continue to see almost half of visits for the five most common skin diagnoses. Patients are often referred from the primary care setting for growths of skin and skin lesions; thus, it is not surprising that actinic keratosis has remained the most common diagnosis among dermatologist and benign neoplasm the third most common dermatologic diagnosis.

Is it Necessary to Send Clinically Diagnosed Benign Skin and Subcutaneous Lesions Excised Under Local Anesthesia for Routine Histopathological Examination?

Background The common benign surgical lesions of skin and subcutaneous tissues like lipoma and sebaceous cysts are diagnosed clinically and treated by surgical excision under local anesthesia. The occurrence of malignancy in these lesions is extremely low, and routine histopathological examination (HPE) adds to increased costs and workload on pathologists. This study was undertaken to estimate the clinical concordance and the frequency of malignancy in these lesions. Methods A total of 1,815 HPE reports of clinically benign skin and subcutaneous lesions excised under local anesthesia from January 2014 to December 2018 were studied. Results Lipoma (31.3%) and sebaceous cyst (29.9%) were the common clinical diagnosis in our study. The clinical accuracy in the diagnosis of lipoma was 88.6%, and for sebaceous cyst, it was 72.7%. There were six reports of malignancy in our study from the clinically diagnosed benign skin and subcutaneous lesions (0.33%). None of the cases of lipoma and the sebaceous cyst had a malignancy in the final histopathology report. The frequency of malignancy in the rest of the lesions is 0.85% (six out of 699 cases); (p-value: 0.003). Discussion In the absence of red flag signs, lesions like lipoma, sebaceous cyst, corn, and callus can be discarded without an HPE. We advocate routine HPE of other solid lesions, cystic lesions with solid areas, and pigmented or ulcerated lesions, as the clinical concordance is low and there is a significant occurrence of malignancy in these lesions.

A Unique Presentation of Birt-Hogg-Dube Syndrome.

Birt-Hogg-Dube (BHD) syndrome is a rare autosomal dominant condition identified by the triad of cutaneous fibrofolliculomas, pulmonary cysts, and renal cell carcinoma. The vast majority of patients with BHD syndrome initially present with spontaneous pneumothorax. This unique case describes a patient with BHD syndrome who presented with sebaceous cysts and perifollicular fibromas. The evaluation by dermatology is what led to his diagnosis. Expanding the clinical presentation of BHD syndrome to encompass a variety of skin findings could help with recognizing these patients before they suffer the serious complications of renal carcinoma and pneumothorax.

A Case of Eccrine Mucinous Carcinoma Involving Scalp.

The report presents a case of a 67-year-old female with a long-standing lump on the scalp. After its excision the histopathology revealed consistency with eccrine mucinous carcinoma. These neoplasms are quite rare with only around 100 cases reported since 1951. The report concludes the importance of encouraging follow-up of cutaneous lesions among patients as well as ongoing research to better identify and manage the tumor.

Misinterpretation of head and neck masses can delay the correct diagnosis. A two-step demolitive-reconstruction surgery for saving patient's life.

OBJECTIVE: To present a rare case of sebaceous cyst masking skin squamous carcinoma. The delayed diagnosis made necessary a two-step (demolition and reconstruction) surgery to save patient's life. MATERIAL AND METHODS: A 77-year-old male, suffering from persistent right hemicrania and eye pain referred to different specialists, who misinterpreted his symptoms. The man presented on the right zygomatic area a big sebaceous cyst which masked a squamous cells carcinoma (SCC) infiltrating the surrounding structures including the orbito zygomatic complex and the orbital content that was the cause of the symptoms. Patient underwent biopsy, CT thorax and MRI of the head and neck as pre-operative examinations. A two-step surgery was performed to remove the tumor. RESULTS: The skin biopsy showed the presence of sun damaged skin contains moderately differentiated invasive SCC within the context of sebaceous cyst. While the CT chest was negative, the head and neck MRI showed a huge tumor invading the orbit and periorbital tissue, the zygomatic bone and the soft tissues up to the posterior orbital area, without presence of neck lymph nodes. Le lesion has been classified as cT4 N0 M0 (TNM 8) and a two-step surgery approach (demolition and reconstruction) was performed with successful results at 1 year-follow up. CONCLUSIONS: The delayed diagnosis of SCC was due to the misdiagnosis of the signs of the tumor invasion. Demolitive and reconstructive surgeries allowed to preserve patient's life. The careful attention to patient's skin characteristic, the analysis of general and local clinical signs (irradiated pain, cyst and skin type) and the evaluation of the complex differential diagnosis could be the key to avoid delayed treatment in head and neck cancer.

Apocrine Hidrocystoma: A Rare Case Report.

Hidrocystoma is a cystic tumor originating from a dilated sweat gland. The tumor is typically small and located predominantly on the face, particularly in the eyelid margins. They are two classical types of hidrocystomas i.e., Apocrine and Eccrine. Apocrine hidrocystomas are cystic lesions that arise from the apocrine secretory coil and Eccrine hidrocystomas represent retention cysts of the eccrine duct. Multiple apocrine hidrocystomas confined to the eyelids have been recognized as a feature of a new variant of ectodermal dysplasia. Here we present a rare case of Apocrine hidrocystoma of supraorbital area for which excisional biopsy of the lesion was performed. Histopathological evaluation proved the lesion was a unilocular cyst lined by a double-layered epithelium of the apocrine type. The purpose of this paper is to report the unique occurrence of a Supra orbital apocrine hidrocystoma which was clinically as a sebaceous cyst and to discuss its differential diagnosis with other more common supraorbital and face lesions.

Umbilical Sebaceous Cyst Mimicking Infected Urachal Sinus.

In addition to the most likely diagnoses for umbilical signs in adults (umbilical hernia, metastatic tumour, endometriosis, congenital abnormalities such as umbilical-urachal sinus and gallstones retained or spilled at the umbilicus), the differential diagnosis should also include epidermoid cyst arising from the skin of the umbilicus. We describe the case of a young man who presented with a persistent umbilical discharge which was initially thought to be umbilical-urachal sinus, but later found to be a sebaceous cyst. LEARNING POINTS: Umbilical sebaceous cysts are rarebut should be included in the differential diagnosis in patients presenting with umbilical discharge, erythema, pain or a palpable mass.They should be considered even when the cystic lesion involves the white line, where remnants of embryonic structures are more likely, as they have been described both above and belowthe fascia, extending and penetrating the white line.Preoperative imaging including ultrasound as well as CT helps to differentiate between umbilical sebaceous cysts and urachal sinus, thusfacilitating adequate preoperative planning to ensure a better outcome.

The Unknown Cause of Pott's Puffy Tumor ­ Importance of Early Diagnose

Pott's puffy tumor (PPT) is characterized by swelling of the glabelar region and osteomyelitis of the frontal bone, owing to a subperiosteal pseudoinflammatory tumor responsible for the detachment of the pericranium from the outer table of the skull. Nowadays, the incidence of PPT is very low, so this entity is frequently underdiagnosed. The late treatment and identification of PPT are strongly associated with intracranial complications, which could jeopardize the life of the patient. In the literature, PPT is described as a complication of frontal head trauma or of chronic sinusitis. There are a few cases reported in patients with frontal insect bites or in recreational nasal drug users, such as cocaine or methamphetamines. In the present case report, the authors describe the case of a 40-year-old male who was submitted to a frontal sebaceous cyst surgery. In the postoperative period, he developed an infectious process compatible with PPT. After an extensive review of the literature, no similar cases were identified. Therefore, in the opinion of the authors, sebaceous cyst surgery should be included in the short list of risk factors for the development of PPT.

Unusual presentation of epidermoid cyst mimicking breast cancer involving the areola-Case report.

INTRODUCTION: Epidermoid cyst is very common benign lesion of the skin. And may appear anywhere on the surface of the body. Diagnosis is made in most cases by clinical examination, but histological evaluation may be needed in unusual cases. PRESENTATION OF CASE: We report a rare case of a 44 year-old woman who presented with a rapidly growing inflamed mass localized to the left areola, which grew to 4 cm in diameter within a few months. The diagnosis of malignancy was ruled out following pathology examination consistent with epidermoid cyst. After a course of antibiotics, she underwent surgery with nipple sparing and reconstruction of the areola. DISCUSSION: Preoperative diagnosis based on biopsy enable limited surgical excision and preservation of the nipple. Reconstruction of the areola by local areolar flap enable good aesthetic result. CONCLUSION: It is important to be aware of this entity of epidermoid cyst mimicking breast cancer, and the treatment options available in these cases.

Sebaceous cyst in the oral cavity.

Sebaceous glands are reported to be normally located in the oral region in the vermilion of the upper lip and on the buccal mucosa. They are small yellowish bodies located immediately beneath the mucosa, and although numerous pathologies of these tissues have been described, very few clinical reports have been made. Pathologies such as ectopic location, hyperplasia, adenomas, carcinomas, and cysts have been described. If an excretory duct suffers a dilatation which does not regress of its own accord, it may originate a cyst. The purpose of this clinical report is to describe a free sebaceous cyst located in the upper lip.

Penile Cutaneous Horn in a 22-month-old Child: A Rare Case Report.

Cutaneous horn is a horn-like hyperkeratotic lesion. Its presence over penis is unusual and rare. Herein, we report a case of horn of penis in a 22-month-old child.

Scrotal skin nodule: sebaceous cyst or tuberculosis? A lesson learnt!

Tuberculosis (TB) is a great mimic of many diseases and may present a dilemma in diagnosis. Sebaceous cyst is the commonest swelling that occurs in the scrotal skin. We present a 23-year-old patient who presented with a painful hard scrotal skin nodule, clinically diagnosed to be an infected calcified sebaceous cyst, excised and reported to be due to TB. Nodular scrotal skin TB is extremely rare but should nonetheless be considered as a differential diagnosis in regions where it is prevalent. Thus, excision of any suspicious nodule is indicated.

Cutaneous metastasis of renal cell carcinoma masquerading as an infected sebaceous cyst.

Renal cell carcinoma (RCC) is the third most common genitourinary malignancy with an estimated one third of cases with metastatic disease at the time of diagnosis. Though rare, cutaneous metastasis from RCC is more frequent than any other genitourinary malignancy. Metastasis of RCC to skin carries poor prognosis as coexistent visceral spread is the norm. A 38-year-old man presented one year after radical nephrectomy for clear cell carcinoma of the left kidney with a submental lesion that proved to be metastatic. Clinical appearance of cutaneous RCC metastasis is varied and can closely mimic other skin lesions. It is incumbent on general practitioners, dermatologists and urologists to exercise diligence in clinical diagnosis of skin lesions in the background of previous oncological diagnosis.

Routine histological examination of epidermoid cysts; to send or not to send?

BACKROUND: The diagnosis of epidermoid cyst is seldom in doubt, and associated malignancy extremely rare, yet it is commonplace for the lesion to be sent to the pathology laboratory for analysis. The aim of this study was to evaluate our current practice with regards to diagnostic accuracy among clinicians, and assess risk of not routinely sending suspected epidermoid cysts for histological examination. Potential cost savings were also estimated and calculated. METHODS: Retrospective analysis of clinical and pathology data on all suspected epidermoid cysts excised from a Scottish district general hospital over a 5-year period between January 2011 and October 2015. RESULTS: Five hundred and thirty-six suspected epidermoid cysts were excised during the study period. Three hundred and ninety-six were sent for histological examination which confirmed a diagnosis of epidermoid cyst in 303 (76.5%) cases. There was good agreement between preoperative suspicion and final histological diagnosis: 80.8% (257/318) among referring clinicians, 81.9% (289/353) among reviewing surgeons, and 88.4% (243/275) where there was preoperative agreement between both. There were no malignant lesions. An average of 80 clinically apparent epidermoid cysts were excised and sent for histology each year at a cost of £4800 per annum. CONCLUSION: There was close agreement between clinical and final histological diagnosis of epidermoid cyst. Where a characteristic, odorous, toothpaste-like material is present on transection intra-operatively, the diagnosis is confirmed and the lesion can be discarded. We argue that significant cost savings can be achieved by adopting this approach.

Twinkle artefact in the ultrasound diagnosis of superficial epidermoid cysts.

AIM: The aim of the study was to evaluate whether the twinkle artefact is a valuable feature in the sonographic diagnosis of superficial epidermoid cysts. MATERIALS AND METHODS: A retrospective search was undertaken of our institution's Radiology Information System and pathology database to identify cases of superficial masses showing the twinkle artefact that proceeded to surgical excision. RESULTS: Eighteen superficial masses demonstrating the twinkle artefact were identified that were submitted for pathological analysis. Of these, 17 were confirmed to represent epidermoid cysts and only 1 case had an alternative diagnosis (proliferating trichilemmal cyst). CONCLUSION: The presence of the twinkle artefact appears to be a specific and valuable ancillary sonographic feature for the diagnosis of superficial epidermoid cysts.

Neurofibromatosis, Down's syndrome, and acquired abnormalities.

We report a patient with Down's syndrome and neurofibromatosis who presented with a keloid, sebaceous cyst and acanthosis nigricans, along with dental and ophthalmological defects. The coexistence of neurofibromatosis type 1 and Down's syndrome which are two unrelated genetic conditions is itself a rarity.

Enucleation of facial sebaceous cyst by creating a minimal elliptical incision through a keratin-filled orifice.

BACKGROUND: A facial sebaceous cyst is a common benign epithelial tumor and surgical excision is frequently performed but may cause obvious scarring and may be esthetically troubling. AIMS: This study evaluated the clinical outcomes of the patients with facial sebaceous cyst enucleated by creating minimal elliptical incisions through a keratin-filled orifice. MATERIALS AND METHODS: Eleven patients with facial sebaceous cyst enucleated by creating minimal elliptical incisions through a keratin-filled orifice. We treated nine male and two female patients aged 25-52 years. The mean cyst size was 1.85 × 1.56 cm. RESULTS: All cysts were successfully enucleated. The mean wound length was 0.93 cm. The mean operative time was 15.2 min. The mean follow-up duration was 41.5 months. No recurrence was noted, and all patients were very satisfied with their esthetic outcomes. All cysts were successfully enucleated. The mean elliptical wound length was 0.93 cm (range, 0.8-1.1 cm). The mean operative time was 15.2 min. We found no evidence of wound infection, or nerve or vascular injury. CONCLUSIONS: Enucleation of facial sebaceous cyst via a minimal elliptical incision through the keratin-filled orifice was associated with high-level patient satisfaction, and the method is safe and useful for treating facial epidermoid cysts.