From the Guidelines
The recommended treatment for a dermoid cyst is surgical removal, which is the only definitive treatment option, as stated in the most recent and highest quality study 1.
Key Points to Consider
- Complete excision of the cyst with its capsule intact is preferred to prevent recurrence.
- The specific surgical approach depends on the cyst's location, with common sites including the ovaries, face, neck, scalp, and spine.
- For ovarian dermoid cysts, laparoscopic cystectomy is often performed, preserving the remaining ovarian tissue when possible, as seen in studies such as 1 and 1.
- For cutaneous dermoid cysts, simple excision under local anesthesia is typically sufficient.
- Surgery is recommended even for asymptomatic dermoid cysts because they can grow over time, potentially causing complications such as rupture, infection, or compression of surrounding structures.
- In rare cases of very large ovarian dermoid cysts, oophorectomy (removal of the entire ovary) might be necessary.
- Post-surgical care typically involves wound care, pain management with over-the-counter analgesics like acetaminophen or ibuprofen, and follow-up to ensure proper healing.
- Dermoid cysts cannot be treated with medications or drainage procedures alone as they contain various tissue types including hair, teeth, and sebaceous material within a capsule that must be completely removed to prevent recurrence, as noted in 1 and 1.
Important Considerations
- The risk of malignancy in dermoid cysts is low, but it is essential to consider this risk when deciding on management, as discussed in 1.
- The O-RADS US risk stratification and management system can help guide the management of dermoid cysts, as outlined in 1 and 1.
- Annual US follow-up is recommended for dermoid cysts that are not surgically excised, especially in postmenopausal women, as stated in 1.
From the Research
Treatment Options for Dermoid Cysts
- The recommended treatment for a dermoid cyst is surgical excision to prevent local complications such as inflammation, infection, and bone resorption 2.
- The type of surgery depends on the size, location, and extension of the cyst, and imaging is usually performed before intervening surgically to check for any deep connections or complications 2.
Surgical Approaches
- For ovarian dermoid cysts, laparoscopic treatment is a safe and effective procedure that can be considered as an alternative to laparotomy in selected cases 3, 4, 5, 6.
- The laparoscopic approach offers several advantages, including shorter hospital stay, quick recovery, and the possibility of conservative treatment, especially in premenopausal women who want to be pregnant 6.
- Vaginal approach with laparoscopic assistance has also been proposed as a safe alternative procedure to laparoscopy for the removal of ovarian dermoid cysts 3.
Considerations for Surgical Treatment
- The risk of chemical peritonitis can be minimized when undertaking laparoscopic removal of ovarian dermoid cysts by washing out the peritoneal cavity thoroughly from spillage of cyst contents and performing drainage in cases of ruptured dermoid cysts 5.
- The use of an impermeable laparoscopic sack can also help to extract the cyst without any peritoneal contamination, reducing the risk of chemical peritonitis 4.