From the Guidelines

Dermoid cysts are typically managed with optional initial follow-up at 8-12 weeks and annual US surveillance if not surgically excised.

In premenopausal patients, dermoid cysts less than 10 cm can be managed with an optional initial follow-up at 8-12 weeks, and if not removed surgically, annual US surveillance should be considered 1.
In postmenopausal patients, dermoid cysts may be considered for annual US follow-up when not surgically excised, but the risk of malignancy should be taken into account 1.
If there is changing morphology or a developing vascular component within the lesion, referral to a US specialist or performance of an MRI study is recommended 1.
Dermoid cysts can be safely followed with yearly US, with a low risk of missing malignant degeneration 1.
The management of dermoid cysts is focused on fertility-preserving surgery and adjuvant chemotherapy, especially in younger patients 1.

The O-RADS US risk stratification and management system provides a means to consistently interpret and manage adnexal lesions, including dermoid cysts 1.
The system includes a condensed lexicon with required descriptors to facilitate risk stratification and management 1.
Individual case management may be modified based on professional judgment, regardless of the O-RADS US recommendations 1.

From the Research

The management of dermoid cysts varies depending on their location and size.

For ovarian dermoid cysts, laparoscopic surgery is a safe and preferred treatment modality 2, 3.
The surgical approach for orbital dermoid cysts is influenced by the anatomic location of the expanded cyst wall and other factors 4.
For dermoid cysts of the conus medullaris, surgical control and restraint are key, especially when patients are young and could potentially fully recover and remain in remission for a period of years 5.
For midline intranasal dermoid cysts with intracranial extension, a multidisciplinary approach is necessary, including neurosurgical and plastic surgery access 6.

Laparoscopic cystectomy or salpingo-oophorectomy can be performed for ovarian dermoid cysts 2, 3.
For orbital dermoid cysts, the surgical approach can vary depending on the location of the cyst, including anterior, superior, medial, or nasoglabellar approaches 4.
For dermoid cysts of the conus medullaris, a midline myelotomy can be performed to drain the cyst and decompress the spinal cord 5.
For midline intranasal dermoid cysts with intracranial extension, a bifrontal approach can be used to remove the intracranial portion, followed by a transcolumellar and infracartilaginous dissection to remove the intranasal portion 6.

The size of the cyst can affect the surgical approach and outcome, with larger cysts potentially requiring more complex surgery 2, 3.
The risk of spillage and chemical peritonitis is a consideration for ovarian dermoid cysts, but can be minimized with proper surgical technique 2, 3.
For dermoid cysts of the conus medullaris, the goal of surgery is to achieve complete recovery and remission, while minimizing the risk of recurrence 5.
For midline intranasal dermoid cysts with intracranial extension, timely preoperative imaging and diagnosis are crucial to the success of the operation 6.