Discussion:
Epidermoid cysts are benign, slow-growing, high, round, firm, subcutaneous, or intradermal cysts that typically grow 1-5 cm in diameter and are usually asymptomatic. It is noteworthy that an epidermoid cyst with a diameter ≥5 cm is rare. 6
Rarely do giant sebaceous cysts or epidermoid cysts appear in surgical practises. These are rare before puberty but can happen at any age. Young adult males are the most common age of presentation. The face, trunk, neck, scalp, scrotum, ear lobe, and breast are the most frequent sites of occurrence, but occurrence at an unusual site is cause for concern. 4
Epidermoid cysts with increased sizes are more brittle and prone to secondary infection. Another crucial point is that the patient may experience depression and anxiety due to the lesion’s aesthetic appearance if these enormous cysts appear in the head or neck due to the high visibility of these areas. 7
A massive epidermal cyst, which is uncommon in surgical practice. According to pathology, the cornified epithelium-lined epidermal cyst has a distinctive granular layer, and lamellated keratin, and is not calcified. There are three different types of lesions: 1) congenital sequestration of surface ectoderm, 2) pilosebaceous unit occlusion, and 3) implantation of epidermal cells into the dermis as a result of surgical intervention and puncturing injury.8
In our case, there were no clinical indications of infection. Since there was no nodal involvement and the lesion was benign, neoplastic conditions were ruled out. Lipomas and salivary vascular lesions are additional conditions to consider, but with the aid of a thorough physical examination and additional tests like ultrasound, and MRI we were able to rule out these other pathological conditions. Importantly, there are reports of malignant changes in epidermoid cysts in the literature. In our case, the pathology-analysed specimen revealed no malignancy.
Although epidermoid cysts have a benign clinical course, there have been a few isolated reports of basal cell carcinoma, squamous cell carcinoma, epithelioid carcinoma, and other malignancies being linked to these cysts. In order to ensure complete removal and prevent recurrence, complete surgical removal is the preferred course of treatment. To get good aesthetic results for giant epidermal cysts, redundant skin must be removed.8
A sebaceous cyst is completely removed along with its capsule as part of the treatment. In one of the few cases to date presented in the literature, the authors describe a rare instance of a massive epidermal cyst that covered the back and required total excision. FNAC typically makes a diagnosis. In order to establish the diagnosis in unusual locations, MRI is a helpful adjunct. Simple excision is the preferred procedure in uncomplicated cases, but regional perforator island flap reconstruction has been used in patients with large epidermal cysts and underlying medical conditions. The outcome of these flaps is determined by the underlying illness and any coexisting diseases.4,9