What is the first line of treatment for a patient experiencing recurrence of a dermoid cyst?

From the Guidelines

The first line of treatment for a patient experiencing recurrence of a dermoid cyst is surgical excision, as it is essential to prevent further recurrence and potential complications. This approach is supported by the fact that dermoid cysts contain developmentally mature tissue that can continue to grow if any remnants are left behind 1.

Key Considerations

• Complete surgical removal of the cyst with its capsule intact is crucial to prevent further recurrence.
• The procedure is typically performed under local or general anesthesia depending on the cyst's size and location.
• For smaller, superficial cysts, a simple excision may be performed in an outpatient setting, while larger or more complex cysts might require more extensive surgery.
• Prior to surgery, imaging studies such as ultrasound, CT scan, or MRI may be ordered to determine the exact size and location of the cyst, as recommended by the O-RADS US Risk Stratification and Management System 1.

Post-Surgical Care

• Antibiotics are generally not needed unless there is evidence of infection.
• Pain management post-surgery typically involves over-the-counter analgesics like acetaminophen or NSAIDs.
• Aspiration alone is not recommended as it leads to high recurrence rates and potential infection, highlighting the importance of complete surgical excision 1.

Surveillance and Follow-Up

• In the premenopausal patient, an optional initial follow-up at 8–12 weeks may be helpful based on the confidence in the diagnosis, and annual US surveillance should be considered if not removed surgically 1.
• In the postmenopausal group, patients with a confident diagnosis of a dermoid cyst may be considered for annual US follow-up when not surgically excised, but the risk of malignancy should be considered when deciding management 1.

From the Research

Treatment of Recurrent Dermoid Cysts

• The first line of treatment for a patient experiencing recurrence of a dermoid cyst is surgical excision 2, 3, 4, 5, 6.
• Incomplete excision of the dermoid cyst can frequently lead to recurrence, highlighting the importance of complete removal during the initial surgery 2.
• The choice of surgical approach may depend on the location and extent of the dermoid cyst, as well as the presence of any complications such as infection or intracranial extension 2, 4.

Surgical Approaches

• Different surgical approaches can be used to excise dermoid cysts, including open, endoscopic, and transcranial approaches 2, 3, 4.
• The choice of approach may depend on the location and size of the cyst, as well as the presence of any complications such as orbital involvement or intracranial extension 2, 4, 5.
• Careful consideration of the surgical approach is necessary to minimize the risk of recurrence and complications 2, 3, 4, 5, 6.

Recurrence Rates

• The recurrence rate of dermoid cysts can vary depending on the location and extent of the cyst, as well as the surgical approach used 2, 3, 4, 5.
• Studies have reported recurrence rates ranging from 0% to 1.4% for lateral brow dermoid cysts 5 and 1.8% for orbital dermoid cysts 4.
• Longer follow-up periods are necessary to determine the true recurrence rate of dermoid cysts 5.