Dermoid cysts in children

What is a dermoid cyst?

A dermoid cyst (also called an ‘inclusion cyst’) is a growth of normal tissue that has become enclosed in a pocket of cells called a sac. This tissue grows in or under the skin with more than eight out of ten dermoid cysts occurring on the head and neck. The most common type of dermoid cyst is a periorbital dermoid cyst. This type of cyst occurs near the outside edge of one of your eyebrows.

The word ‘dermoid’ refers to something that is like skin. Dermoid cysts mostly contain skin cells and oils (sebum) and sometimes hair follicles.

The term dermoid is used to describe the following types of cysts:

• Simple cysts under the skin.
• Cysts with hair follicles.
• Deeper neck cysts with contents of oil, skin, and/or hair follicles.

Dermoid cysts are usually present at birth, most commonly diagnosed in young children (below the age of five years), and are slow growing.

What causes a dermoid cyst?

Dermoid cysts are congenital (present at birth). As the baby develops in the womb, the skin layers do not always fuse together as they should. Skin cells, glands that make sweat and oils (sebum), can collect under the skin in a small sac-like structure. Over time as further oils or fluid are produced, the cyst can get bigger.

What are the symptoms of a dermoid cyst?

A dermoid cyst is felt as a firm, movable, usually painless lump under the skin which can grow slowly over time. Very rarely, if the cyst is near the eye and increases in size, it can put pressure on the eye, causing discomfort.

How are dermoid cysts diagnosed?

Dermoid cysts are usually diagnosed by physical examination. Scans (such as ultrasound) are usually only needed if the cyst is close to the eye (called an external orbital dermoid cyst) but this will be discussed with you during the consultation.

Treatment and management

Although dermoid cysts do not usually cause pain or discomfort and most are harmless, they can become infected, rupture, or put pressure on nearby nerves or bone. They can also slowly continue to increase in size and so affect appearance.

Treatment in the form of a surgical procedure to excise (remove) the cyst is usually offered. The removal is undertaken as a day-case operation whilst your child is fully asleep under a general anaesthetic. Depending on the location of the dermoid cyst, it may require a general paediatric surgeon or plastic surgeon to perform the operation.

The removed tissue will be sent to the laboratories where it will be examined under a microscope to confirm the diagnosis.

Are there alternative treatments?

Occasionally, after discussion with doctors, families may decide not to have their child’s dermoid cyst removed. This often depends on size and location of the cyst. A dermoid cyst will not resolve on its own and without a surgical procedure to remove it, infection can occur, so medical advice should be sought in this scenario.

When to seek medical advice

Medical advice should be sought if the cyst becomes inflamed (swelling), becomes painful, changes colour, gets bigger, appears infected or ruptures (bursts).

Chaperoning

During your child’s hospital visits they will need to be examined to help diagnosis and to plan care.

Examination, which may take place before, during and after treatment, is performed by trained members of staff and will always be explained to you beforehand. A chaperone is a separate member of staff who is present during the examination.

The role of the chaperone is to provide practical assistance with the examination and to provide support to the child, family member/ carer and to the person examining.

Contacts/Further Information

For further information, contact the paediatric surgery/urology clinical nurse specialist team:

• Office: Tel 01223 586973

(Monday to Friday 08:00 to 18:00 except bank holidays)