From the Guidelines
Dermoid cysts are typically benign and can be managed with surgical removal, but it's crucial to consider the risk of malignancy, especially in postmenopausal women, and to follow up with annual US surveillance if not surgically excised, as recommended by the most recent guidelines 1.
Key Points to Consider
- Dermoid cysts are the most common type of ovarian tumor, but they are nearly always benign, with a rare malignant transformation rate of 1%–2% 1.
- The management of dermoid cysts involves surgical removal to prevent recurrence, and complete excision is essential to avoid cyst recurrence.
- The procedure is usually straightforward and can be performed under local or general anesthesia, depending on the cyst's size and location.
- Surgery is generally recommended even for asymptomatic dermoid cysts because they can gradually enlarge over time, potentially causing pressure on surrounding structures, infection, or cosmetic concerns.
- The O-RADS US risk stratification and management system provides guidelines for managing dermoid cysts, including annual US follow-up for premenopausal patients with a confident diagnosis and not surgically excised 1.
Important Considerations for Management
- The risk of malignancy is higher in postmenopausal women, and the presence of ascites and/or peritoneal nodules can indicate a high-risk category (≥50% risk of malignancy) 1.
- The individual O-RADS descriptors, such as irregular solid lesions and multilocular cysts with a solid component and high color score, can help predict the risk of malignancy.
- Referral to a US specialist, gynecologist, or MRI may be necessary for further evaluation and management, especially if there is changing morphology or a developing vascular component within the lesion.
- The optimal duration or interval of timing for surveillance has not been established, but evidence supports an increasing risk of malignancy in endometriomas following menopause 1.
From the Research
Dermoid Cyst Overview
- A dermoid cyst, also known as a mature cystic teratoma, is a common benign neoplasm of the ovary in women 2.
- It requires treatment due to the risk of torsion, rupture, and malignant change 2.
Treatment Options
- Laparoscopic surgery is a preferred treatment modality for dermoid cysts 2, 3, 4, 5.
- Vaginal approach with laparoscopic assistance has been proposed as an alternative to total laparoscopic removal 3.
- Laparoscopic ovarian dermoid cystectomy is associated with a longer operating time than laparotomy, but the duration of hospitalization is shorter and recovery is faster 4.
- Laparoscopic surgery is safe for dermoid cysts of the ovary even with rupture and spillage of its contents 2, 4.
Risk Factors for Adnexal Torsion
- Adnexal torsion involving dermoid cysts is associated with younger age, but not with the mean cyst's diameter 6.
- Surgical removal of dermoid cysts should be considered in pre-menarchal girls, adolescents, and young women to prevent adnexal torsion 6.
- Nausea and/or vomiting are significantly more common in patients with adnexal torsion than in those without torsion 6.
Comparison of Surgical Approaches
- Laparoscopic approach has many advantages, including less post-surgical pain, shorter hospitalization, and fewer post-surgical complications compared to laparotomy 5.
- Vaginal removal of dermoid cysts has few, but significant, advantages, especially regarding operating time, intraperitoneal spillage of dermoid tissue, and post-operative outcome 3.