Differential diagnoses: Cysts

Dr Nigel Stollery compares four presentations and offers clues for their diagnosis including epidermoid cysts, meibomian cysts, digital myxoid cysts and trichilemmal cysts.

Epidermoid cyst

Presentation

  • Occur anywhere on the body in areas with relatively little hair
  • Size varies from a few millimetres to 2cm
  • Multiple cysts may occur
  • Often associated with telangiectasia
  • Usually asymptomatic, but may be painful if secondary infection occurs
  • May discharge cheesy sebum and keratin
  • Occur after implantation of the epidermis into the dermis because of trauma, such as piercing

Management

  • May resolve spontaneously
  • Treatment of choice is surgical excision

Meibomian cyst

Presentation

  • Also known as chalazion or tarsal cyst
  • Vary in size; 2-8mm in diameter
  • Multiple cysts may occur, affecting both eyelids
  • More common on upper eyelid
  • Secondary infection may occur
  • Arise from meibomian glands
  • Often acute, but may persist and become chronic swellings
  • More common in patients with blepharitis or eczema

Management

  • Initially no treatment is advised
  • Usually last two to six months without treatment
  • Hot compresses can be helpful
  • Surgical incision under local anaesthetic may be required
  • May recur, but most will not

Digital myxoid cyst

Presentation

  • Occur on finger ends
  • Result of degeneration in connective tissue
  • May connect with the underlying joint
  • Smooth surface and varied sizes
  • When overlying nail, may produce a groove as nail grows
  • Contain jelly-like, sticky fluid
  • Often associated with underlying osteoarthritis

Management

  • Treatment not always required
  • Pressure may lead to rupture
  • Aspiration can be undertaken
  • Treatments include cryotherapy
  • In recurrent cases, surgical excision can be undertaken

Trichilemmal cyst

Presentation

  • Also known as pilar cyst
  • Most (70%) associated with other cysts, but 30% are solitary
  • More common on hair-bearing areas, especially scalp (90%)
  • Derived from outer root sheath of hair follicle
  • Smooth surface and mobile
  • Filled with keratin
  • There may be a family history
  • Malignant transformation may occur, but is extremely rare

Management

  • Treatment not always required
  • If required, surgical excision can be undertaken
  • Failure to remove cyst capsule increases risk of recurrence

Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary.

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