Dermoid Cyst

What is a dermoid cyst?

A dermoid cyst is a benign (noncancerous) sac-like growth that is present from birth. It forms when skin cells and the structures that normally sit in skin become trapped in the wrong place while a baby is developing in the womb. Because of this, the sac is lined with skin-type tissue and often contains material that skin would normally produce, such as oily fluid, hair, sweat-gland secretions, and sometimes small pieces of teeth, bone, or cartilage.

Dermoid cysts are one of the more common congenital (present at birth) growths seen by doctors. They can occur almost anywhere, but a few locations are especially typical:

• Head, face, and neck – most often near the outer end of the eyebrow, on the scalp, at the bridge of the nose, or under the tongue and in the floor of the mouth.
• Ovary – here the growth is usually called a mature cystic teratoma, another name for an ovarian dermoid cyst. It is one of the most common benign ovarian tumors in women of reproductive age.
• Spine and brain – rare, but a dermoid cyst can sit near the spinal cord or inside the skull, where it may press on nearby nerve tissue.

Cysts on the skin are usually noticed in infants and young children, while ovarian dermoid cysts are often found in adolescents and adults, sometimes by chance during a scan done for another reason. Although a dermoid cyst is not cancer, it does not go away by itself and tends to enlarge very slowly over years.

Dermoid cyst symptoms

Many dermoid cysts cause no symptoms at all. When symptoms do appear, they depend mainly on where the cyst is and whether it has become inflamed, infected, or large enough to press on surrounding structures. Common dermoid cyst symptoms include:

• A small, firm, painless lump under the skin, often round and smooth
• A lump that has been present since infancy and grows slowly, if at all
• Skin over the lump that looks normal or slightly stretched, without an obvious opening
• Redness, warmth, tenderness, or swelling if the cyst becomes infected
• Drainage of oily or cheesy material if an infected cyst ruptures
• Pelvic or lower abdominal pressure, fullness, or dull pain with an ovarian dermoid cyst
• Sudden, severe lower abdominal pain if an ovarian cyst twists (a complication called ovarian torsion) or bursts
• Headache, weakness, numbness, or problems with balance or bladder control if a rare spinal or brain dermoid cyst presses on nerves

Skin and face: the classic presentation is a parent noticing a pea- to marble-sized bump near a child’s eyebrow or on the scalp. It usually does not hurt and does not move as freely as a simple fatty lump, because it may be attached to deeper tissue or bone. A dermoid cyst on the nose or scalp sometimes has a tiny dimple or pit on the skin surface and can, in some cases, connect inward toward the skull, which is one reason doctors often image these before removing them.

Ovary: most ovarian dermoid cysts are silent and are discovered on a routine pelvic ultrasound. Larger cysts may cause a feeling of heaviness, bloating, pain during intercourse, or changes in menstrual patterns. Torsion, where the weight of the cyst causes the ovary to twist on its blood supply, causes sudden intense pain, often with nausea and vomiting, and is a medical emergency.

Spine or brain: symptoms here develop slowly and reflect the affected area, for example back pain, leg weakness, or, in the skull, headaches and seizures. If the cyst leaks its contents, it can trigger inflammation of the membranes around the brain, causing sudden severe headache and fever.

Dermoid cyst causes and risk factors

The underlying dermoid cyst cause is a developmental event before birth, not anything a person or parent did. During the first weeks of pregnancy, layers of tissue fold and fuse to form the face, skull, spine, and other structures. If a small pocket of skin-forming cells gets pinched off and sealed inside as these layers close, that pocket keeps behaving like skin: it sheds cells, grows hair, and produces oil, all of which build up inside a closed sac. Over time the sac slowly enlarges.

Ovarian dermoid cysts arise a little differently. They develop from germ cells, the primitive cells in the ovary that can turn into many tissue types. When such a cell begins to grow in a disorganized way, it can form a cyst containing skin, hair, teeth, fat, or even thyroid tissue. This is why the medical term is teratoma, from a Greek word meaning growth of mixed tissues.

Known and suspected risk factors are limited, because dermoid cysts are largely random developmental events. Points doctors generally accept include:

• Being born with the cyst – the cyst itself is congenital, even if it is found decades later.
• Female sex and reproductive age – ovarian dermoid cysts are most often diagnosed in women in their twenties and thirties, although they can occur at any age.
• A previous ovarian dermoid cyst – a cyst on one ovary somewhat increases the chance of one on the other ovary, either at the same time or later.
• Location along embryonic fusion lines – areas such as the outer eyebrow, midline of the nose, neck, and lower spine are where trapping of skin cells is most likely to occur.

Dermoid cysts are not caused by infection, injury, diet, or lifestyle, and they are not generally considered hereditary, although rare families with several affected members have been described. There is no known way to prevent them.

Dermoid cyst diagnosis

Dermoid cyst diagnosis usually starts with a careful history and physical examination. For a lump on the skin, a doctor will ask when it was first noticed, whether it has changed, and whether it has ever been red or painful. On examination, a dermoid cyst typically feels firm, smooth, and rubbery, and it may be slightly fixed to the underlying bone. These features help distinguish it from other common lumps such as an epidermoid cyst (a similar sac that develops later in life rather than before birth) or a lipoma (a soft fatty lump).

Imaging is frequently used to confirm the diagnosis and, importantly, to plan safe removal. Depending on the location, your doctor may recommend:

• Ultrasound – uses sound waves to show the size of the cyst, its contents, and whether it is fluid-filled or solid. It is the first-line test for suspected ovarian dermoid cysts and is often used for superficial lumps in children because it involves no radiation.
• CT (computed tomography) scan – a detailed X-ray-based scan that is particularly good at showing fat, calcium, or teeth inside a cyst and at checking whether a cyst on the scalp or nose extends through the bone.
• MRI (magnetic resonance imaging) – uses magnetic fields to produce detailed pictures of soft tissue. It is preferred when a cyst may be connected to the brain or spinal cord, or when the diagnosis is uncertain.
• Blood tests – for ovarian cysts, doctors sometimes measure tumor markers to help assess the very small chance that a growth is not benign, though these tests are not specific and are interpreted together with imaging.

Doctors generally avoid needle biopsy of a suspected dermoid cyst on the head or spine, because puncturing a cyst that connects inward can introduce infection. The definitive diagnosis is made by histopathology, meaning a pathologist examines the removed cyst under a microscope and confirms that it is lined with skin-type tissue and contains skin structures.

Dermoid cyst treatment options

Dermoid cyst treatment depends on the cyst’s location, size, symptoms, and the patient’s age and overall health. Because the cyst is congenital and does not resolve on its own, complete surgical removal is the standard definitive treatment in most cases, but not every cyst needs to be removed immediately.

Observation: small, symptom-free ovarian dermoid cysts, especially in women who wish to preserve fertility or who have other health issues, may be followed with periodic ultrasound rather than operated on right away. Your doctor may suggest monitoring if the cyst is small and shows typical benign features. Cysts on the face and scalp in very young infants are sometimes watched for a period before surgery is scheduled at a safer age, provided there is no sign of infection or deep extension.

Medication: there is no medicine that shrinks or dissolves a dermoid cyst. If a cyst becomes infected, antibiotics may be prescribed to control the infection, and an abscess may need to be drained. However, antibiotics treat only the infection, not the cyst itself, and removal is usually planned once the inflammation has settled. Pain relievers may be used for discomfort while awaiting surgery.

Surgical removal (excision): the goal is to remove the entire sac intact. If the lining is left behind, the cyst is likely to come back, and if the contents spill during removal they can cause irritation of surrounding tissue. The approach varies:

• Skin, face, and scalp cysts are typically removed under general anesthesia in children or local anesthesia in cooperative adults, through a small incision placed to minimize visible scarring, often hidden in an eyebrow or hairline. The procedure is usually a day-case operation.
• Ovarian dermoid cysts are most often removed by laparoscopy (keyhole surgery using a camera and slim instruments through small abdominal incisions). Surgeons usually perform an ovarian cystectomy, removing the cyst while preserving the healthy part of the ovary. In some situations, for example a very large cyst, suspicion of a more serious growth, or a twisted ovary that is no longer viable, removal of the whole ovary may be necessary.
• Spinal or intracranial cysts require specialized neurosurgery. Complete removal may not always be possible if the cyst is stuck to delicate nerves, in which case the surgeon removes as much as is safely possible and monitors the remainder.

Recovery and follow-up: after removal of a skin cyst, most people return to normal activity within days, with stitches removed or dissolving within one to two weeks. Recovery from laparoscopic ovarian surgery typically takes one to a few weeks. The removed tissue is sent to pathology to confirm the diagnosis. Follow-up visits check wound healing and, for ovarian cysts, may include an ultrasound at intervals to monitor the remaining ovary.

Which specialist manages the cyst depends on its site. Skin, face, and neck cysts are often handled within general surgery or pediatric surgery, ovarian cysts by gynecology, and cysts near the eye, brain, or spine by the relevant surgical subspecialty. At Acibadem, superficial dermoid cysts are usually assessed and removed through the general surgery department.

Living with a dermoid cyst and outlook

For most people, the outlook after treatment of a dermoid cyst is very good. Because the growth is benign, complete removal is generally curative, and recurrence is uncommon when the entire sac has been taken out. A person who has had a cyst removed does not usually need ongoing treatment, although a scar will remain and, in cosmetically sensitive areas such as the face, surgeons take care to place incisions discreetly.

If you are being monitored rather than treated, it is reasonable to keep scheduled scans and to be aware of changes such as growth, new pain, or redness. Ovarian dermoid cysts that are observed rather than removed carry a small ongoing risk of torsion, rupture, or growth, so your doctor will weigh this against the risks of surgery when advising you. Ovarian cystectomy is designed to preserve fertility, and many women go on to conceive normally, although any ovarian surgery can reduce the reserve of eggs to some degree.

Cancerous change within a dermoid cyst is rare and, when it occurs, is mostly seen in older women with long-standing ovarian cysts. Careful pathology examination after removal is the way this is checked. For spinal or brain dermoid cysts, outcomes depend on how completely the cyst could be removed and whether nerve tissue was affected before surgery; some people need longer follow-up imaging. Honest discussion with your surgical team about the likely benefits, risks, and alternatives will help you decide on the right plan for your situation.

Frequently asked questions

Is a dermoid cyst cancerous?

In the vast majority of cases, no. A dermoid cyst is a benign growth made of normal tissues, such as skin and hair, that developed in an unusual place. A small proportion of ovarian dermoid cysts, mainly in postmenopausal women or with very large cysts, can contain cancerous cells, which is one reason removed cysts are always examined by a pathologist.

What are the first dermoid cyst symptoms people notice?

On the skin, the first sign is usually a painless, firm lump, often present since infancy and commonly near the eyebrow or on the scalp. With ovarian dermoid cysts, many women notice nothing until a scan detects the cyst; others report pelvic pressure, bloating, or period changes. Sudden severe pelvic pain may signal a complication and needs urgent assessment.

What causes a dermoid cyst to form?

Dermoid cyst causes trace back to early development in the womb, when a pocket of skin-forming cells becomes trapped as tissues fuse. In the ovary, the cyst grows from germ cells that can produce many tissue types. Nothing a parent or patient did causes the cyst, and lifestyle factors are not known to play a role.

How is dermoid cyst diagnosis confirmed?

Doctors combine a physical examination with imaging, most commonly ultrasound, and sometimes CT or MRI to check the contents of the cyst and whether it extends toward bone, brain, or spinal cord. The diagnosis is finally confirmed when the removed cyst is examined under a microscope.

Can a dermoid cyst go away without treatment?

No. Because the sac is lined with living skin cells that keep producing oil and shedding debris, a dermoid cyst does not shrink or disappear on its own. It may stay stable for years, but it cannot resolve without removal. Small, symptom-free cysts can sometimes be safely watched.

What does dermoid cyst treatment involve and is surgery always needed?

The definitive dermoid cyst treatment is surgical removal of the whole sac, often as a day-case procedure for skin cysts and by keyhole surgery for ovarian cysts. Surgery is not always urgent; your doctor may recommend observation for a small, uncomplicated cyst, or antibiotics first if a cyst is infected, with removal planned later.

Will a dermoid cyst come back after removal?

Recurrence is uncommon when the cyst has been removed completely with its lining intact. If part of the lining is left behind, for example because it was stuck to important structures, the cyst can slowly regrow, so surgeons aim for complete excision whenever it is safe to do so.

When to see a doctor

Any new or long-standing lump should be checked by a doctor so the cause can be identified, even if it is painless. Seek urgent medical attention if you or your child has:

• Sudden, severe lower abdominal or pelvic pain, especially with nausea or vomiting, in someone known to have an ovarian cyst
• A lump that rapidly becomes red, hot, swollen, or very painful, or begins to drain pus
• Fever together with a painful or draining cyst
• A lump on the scalp, nose, or spine that leaks clear fluid
• Sudden severe headache, stiff neck, confusion, or seizure in someone with a known head or spine dermoid cyst
• New weakness, numbness, difficulty walking, or loss of bladder or bowel control
• Rapid growth of a lump, or a lump that becomes hard, irregular, or fixed to surrounding tissue

These signs may indicate infection, rupture, torsion, or pressure on nerves, all of which need prompt evaluation. If a cyst is being monitored, keep planned follow-up appointments and report any change in size or symptoms.