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A Rare Presentation of a Giant Epidermoid Inclusion Cyst Mimicking Malignancy
Tarin Paparella1, Lawrence Fallat2
1Postgraduate Year 3 Resident, Podiatric Surgery Residency Program, Beaumont Hospital Wayne, Wayne, MI.
Insights
Giant epidermal cysts are rare, large benign skin lesions. This case report details an unusual, rapidly growing giant epidermal cyst on a patient's hallux, mimicking malignancy.
Area of Science:
- Dermatology
- Pathology
- Surgical Oncology
Background:
- Epidermal inclusion cysts are common benign skin lesions.
- Giant epidermal cysts are a rare subtype, characterized by larger size and lack of a central punctum.
- Cysts on acral surfaces like the foot are uncommon.
Observation:
- A 57-year-old male presented with a rapidly growing, large, ulcerated lesion on the medial hallux.
- The lesion exhibited atypical features, raising suspicion for malignancy due to its size, location, and ulceration.
- Underlying osseous changes were noted, further complicating the initial diagnosis.
Findings:
- The case involved a giant epidermal cyst on the foot, an unusual location for this type of lesion.
- The cyst presented atypically with rapid growth and ulceration, mimicking a malignant tumor.
- Diagnostic challenges included differentiating the benign cyst from a malignant neoplasm based on clinical and imaging findings.
Implications:
- This case highlights the importance of considering giant epidermal cysts in the differential diagnosis of large, atypical foot lesions.
- Understanding the unique characteristics and potential for aggressive presentation of giant epidermal cysts is crucial for accurate diagnosis and treatment.
- Further investigation into the etiology and management of these rare tumors is warranted.
Abstract:
Epidermoid inclusion cysts, infundibular cysts, and retention cysts are dense, well-encapsulated benign soft tissue lesions that develop after a portion of the epidermis has become implanted in the dermis on a follicular surface such as the scalp, face, or trunk. However, on acral surfaces such as the palms and soles, these cysts present <10% of the time. Typically, these lesions will not progress to sizes >5 cm. However, a rare subtype of epidermal cysts known as giant epidermal cysts tends to be much larger. Unlike epidermal inclusion cysts, giant cysts lack a central punctum, present on areas of thick skin lacking hair follicles, and affect an older patient population. Because of their large size and unique characteristics, few cases of giant epidermal cysts localized to the foot have been reported. We present a case report of a 57-year-old male with a rapidly growing, large, ulcerated, atypical epidermal inclusion cyst that had developed on the medial aspect of his hallux with underlying osseous changes. In this particular case, the location, overlying skin changes, and rapid growth of the lesion raised suspicion for malignancy. In the present report, we discuss the unusual features of this particular cyst and the etiologies, treatment course, and short-term outcomes regarding this unique tumor.
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