Pediatric Dermoid Cysts
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What Is a Dermoid Cyst?
A dermoid cyst is a sac-like growth located within the skin, or in soft tissue deep to the skin. These cysts are benign (non-cancerous) and can be anywhere on the body.
A dermoid cyst is present at or shortly after birth, but may not be noticed because it grows slowly. In children, dermoid cysts are most commonly found on the face, neck, scalp or upper chest. Sometimes a dermoid cyst can form below the skin and grow into the body, for example, on the ovary or the spine.
Dermoid cysts contain fluid or semisolid material. They may also contain normal tissue such as skin, hair, nerves, sweat glands and sometimes even cartilage, bone fragments or teeth.
Dermoid cysts do not go away on their own. They may grow bigger with time or become infected. Although a dermoid cyst is usually harmless, it can cause discomfort or other issues if not treated. Healthcare providers often remove these cysts with surgery.
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What Causes Dermoid Cysts in Children?
Dermoid cysts occur during the early stages of fetal development, when layers of specialized cells don’t grow together properly. Healthy cells that should be on the outside of a baby’s body—such as cells from skin, sweat glands or hair — become trapped inside the body. Over time these cells and tissues collect inside a sac. They produce material, causing the cyst to grow.
What Are the Symptoms of a Dermoid Cyst?
Many people with dermoid cysts have no symptoms. Some start to experience symptoms as their cysts grow. Typically:
- A small, firm lump or bump under the skin is the most common and noticeable symptom of a dermoid cyst.
- The cysts are often movable under the skin.
- Dermoid cysts grow slowly over time.
- The lump or bump may be the same color as your child’s skin or pale yellow.
- Cysts usually appear near the eyebrow or on the scalp, chest or collarbone. They can also occur on or around the ear, on the nose, in the floor of mouth or tongue, or in the midline neck.
- Dermoid cysts are usually painless, but they can become uncomfortable or tender if they grow large or become infected.
Dermoid cysts do not usually cause other symptoms unless they are pressing on nearby structures or become infected. Symptoms vary depending on the type and location of the dermoid cyst. Always consult your child’s physician for evaluation and management.
How Is a Dermoid Cyst Diagnosed?
Most dermoid cysts are diagnosed in children before age 5. About 40% of dermoid cysts are diagnosed at birth. Diagnosis typically involves:
- Physical examination by your child’s doctor to examine the cyst and the area around it
- Tests such as ultrasound, CT scan or MRI (magnetic resonance imaging) to provide images of the cyst and surrounding tissue and to confirm the diagnosis
The most common type of dermoid cyst is a periorbital dermoid cyst, which occurs near the outside edge of one of the eyebrows.
Other common types are ovarian (on or in the ovary) or spinal (on the spine) dermoid cysts.
Rarer types include epibulbar (or limbal, on the surface of the eye), intracranial (in the brain), nasal (inside the nose) or orbital (around the bones of the eye socket) dermoid cysts. Other locations are on or around the ear, in the oral cavity, and in the midline neck.
How Are Dermoid Cysts Treated?
Treatment depends on the size, location (type) and symptoms of the dermoid cyst. Your child’s physician will recommend specific treatment based on expectations for the course of the condition; your child’s age, overall health and medical history (including their tolerance for specific medications, procedures or therapies); and your opinion or preference.
Treatment options may include:
- Observation: If the cyst is small and not causing any symptoms, the doctor may recommend simply monitoring it over time.
- Antibiotics: If the cyst becomes infected, antibiotics may be used to treat the infection before any surgical intervention. However, it is easier to remove cysts and prevent scars before the cyst gets infected.
- Surgical removal: This is the most common treatment for dermoid cysts. In most cases, your child’s doctor will recommend waiting until the child is at least six months old to undergo surgery. During surgery, the cyst and its lining are removed through a simple incision in the skin to prevent recurrence. The incision is often closed with dissolvable sutures and covered with a bandage. If the cyst has any connection with the skull or tissues deeper within the body, the procedure is performed with a plastic surgeon and a neurosurgeon.
Surgery to remove a dermoid cyst is often done under general anesthesia, especially in young children. It is typically scheduled as an outpatient procedure, which means your child can go home on the same day as their surgery.
What Are Possible Complications of a Dermoid Cyst in Children?
Having your child’s cyst removed can help manage any symptoms and prevent future complications. While dermoid cysts are generally benign and treatable, there are some potential risks and complications:
- If a cyst becomes infected, it can cause pain, redness and swelling, and may require antibiotics or drainage.
- Although it’s rare, a cyst can rupture, leading to inflammation and infection.
- If the cyst is not completely removed during surgery, it may recur.
- In some cases, a cyst can press on nearby tissues or organs, causing discomfort or other symptoms.
Early intervention and follow-up with your child’s doctor can help prevent potential complications of a dermoid cyst and ensure your child’s health and well-being.