Key Questions to Ask an 18-Year-Old Patient with an Epidermoid Cyst on the Chest
For an 18-year-old patient with an epidermoid cyst on the chest, focus your questioning on duration, symptoms, and risk factors for malignancy, as incision and drainage is the recommended treatment for inflamed epidermoid cysts.
History Questions
Duration and Growth Pattern
- How long has the cyst been present?
- Has it changed in size, shape, or appearance recently?
- Has it grown rapidly in the past few weeks or months?
- Have you noticed any fluctuation in size?
Symptoms
- Is the cyst painful or tender to touch?
- Do you have any discomfort when moving your arms or chest?
- Have you noticed any discharge from the cyst?
- If discharge is present, what is its color and consistency?
- Have you had any fever, chills, or general malaise?
Previous Management
- Have you tried to squeeze or drain the cyst yourself?
- Have you applied any topical medications or home remedies?
- Have you had similar cysts in the past? If so, how were they treated?
- Have you had any previous surgeries for cyst removal?
Risk Factors for Malignancy
- Is the cyst fixed to adjacent tissues?
- Is the consistency firm?
- Is the size greater than 1.5 cm?
- Is there ulceration of the overlying skin?
- Have you noticed any changes in the overlying skin (redness, warmth, ulceration)?
- Do you have a family history of skin cancer or other malignancies?
Physical Examination Focus Points
Cyst Characteristics
- Size of the cyst (measure in centimeters)
- Presence of a central punctum (opening)
- Mobility (whether it's freely mobile or fixed to surrounding tissues)
- Consistency (soft, firm, or hard)
- Presence of inflammation (redness, warmth)
- Tenderness on palpation
Surrounding Tissues
- Check for regional lymphadenopathy
- Assess for any satellite lesions
- Evaluate for skin changes around the cyst
Management Considerations
According to the Infectious Diseases Society of America guidelines, the following approach is recommended 1:
- Gram stain and culture of pus from inflamed epidermoid cysts are not recommended
- Incision and drainage is the recommended treatment for inflamed epidermoid cysts
- For non-inflamed cysts, complete surgical excision is typically the treatment of choice
Important Caveats
- While epidermoid cysts are typically benign, malignant transformation to squamous cell carcinoma can occur, though it is rare 2
- Any cyst with suspicious features (rapid growth, fixation to surrounding tissues, ulceration, or size >1.5 cm) should prompt consideration for complete excision and histopathological examination 1
- Recurrence is possible if the cyst wall is not completely removed during surgical excision 3
- Multiple epidermoid cysts may be associated with certain genetic syndromes and warrant further investigation 3
By asking these targeted questions and performing a thorough examination, you can determine the appropriate management approach for this patient's epidermoid cyst while ensuring you don't miss any concerning features that might suggest malignancy.