Epidermoid Cysts Mimicking Hand Abscesses: A Case Series Highlighting Diagnostic Challenges and Surgical Management

Epidermoid cysts are benign, slow-growing cutaneous lesions that can develop in various regions of the body, including the hands. Due to their nonspecific clinical presentation, they are frequently misdiagnosed as abscesses, particularly in patients with a history of trauma. Misdiagnosis can lead to inappropriate management, delaying definitive treatment. We report 2 cases of epidermoid cysts initially misdiagnosed as hand abscesses. The first patient, a 37-year-old man, presented with a 1-month history of swelling, pain, and purulent discharge from the left index finger. The second patient, a 59-year-old man, had a 3-day history of a progressively enlarging, painful mass on the palmar surface of the left hand, with a history of trauma 4 months prior. Both patients underwent bedside incision and drainage in the emergency department, followed by surgical exploration in the operating room due to persistent symptoms. A jelly-like material was observed intraoperatively, prompting histopathologic evaluation, which confirmed the diagnosis of epidermoid cysts in both cases. Epidermoid cysts can closely mimic abscesses due to their similar presentation. A thorough patient history and clinical examination are essential for accurate diagnosis. When uncertainty exists, histopathologic evaluation is necessary to confirm the diagnosis and guide appropriate treatment. Complete surgical excision is the definitive management method to prevent recurrence and complications.