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