Medical Terminology for Facial Cysts
The most common medical terms for cysts on the face are epidermoid cyst and dermoid cyst, with epidermoid cysts being the most frequently encountered benign cutaneous cyst presenting as a mobile, flesh-colored nodule with a characteristic central punctum. 1, 2
Primary Types of Facial Cysts
Epidermoid Cyst
- Most common benign cutaneous cyst that frequently occurs on the face, scalp, neck, and trunk 3, 4
- Contains cheesy keratinous material and normal skin flora even when uninflamed 1
- Presents as a firm, mobile, flesh-colored nodule with a characteristic central punctum (small opening) 2
- More frequent in males and usually asymptomatic unless complicated 4
Dermoid Cyst
- Congenital choristomas containing more complex structures like hair, teeth, and cartilage due to their developmental origin 1
- Typically present earlier in life than epidermoid cysts 2
- On ultrasound, show hyperechoic components with acoustic shadowing, hyperechoic lines and dots, and sometimes fluid-fluid levels 1, 5
Pilar Cyst (Trichilemmal Cyst)
- A subtype often found on the scalp, back, and face 6
- Arise from hair follicle epithelium and occur in about 10% of the population 7
- More common in women and carry low malignancy potential 6
Critical Clinical Distinctions
When to Suspect Malignancy
Any chronic facial cyst with the following features requires biopsy: 2
- Marked asymmetry or rapid growth
- Ulceration or indurated, irregular borders
- Fixation to underlying structures
- Loss of normal tissue architecture or focal hair loss
- Unresponsive to standard therapy despite treatment
Inflamed Cyst vs. Abscess
- Inflamed epidermoid cyst: longstanding nodule that recently became inflamed, containing thick white-yellow keratinous debris mixed with pus 2
- Abscess: develops over days without pre-existing mass 2
- This distinction is critical because inflammation in epidermoid cysts results from rupture of the cyst wall and extrusion of contents into dermis—not true bacterial infection 2
Management Approach
Standard Treatment
- Complete surgical excision is the definitive treatment to prevent recurrence 5
- All surgically excised cysts should undergo pathologic evaluation 3
Management of Inflamed Cysts
- Effective treatment involves incision and thorough evacuation of contents, probing the cavity to break up loculations, and covering with dry dressing 1
- Systemic antibiotics are rarely necessary unless complicating factors exist: multiple lesions, cutaneous gangrene, severely impaired host defenses, extensive surrounding cellulitis, or severe systemic manifestations 1, 5
- Gram stain and culture of pus from inflamed epidermoid cysts is not recommended 5
Important Pitfalls to Avoid
- Do not misdiagnose inflamed epidermoid cyst as simple abscess, which leads to inappropriate antibiotic use without addressing the cyst wall, resulting in recurrence 2
- Do not prescribe antibiotics alone for inflamed cysts without adequate drainage, as this is insufficient 2
- Maintain low threshold for biopsy of any suspicious lesion, as malignant transformation to squamous cell carcinoma, though rare, has been documented 3, 8
- For facial masses present ≥2 weeks without fluctuation, fixed to adjacent tissues, firm in consistency, >1.5 cm, or with ulceration of overlying skin, rule out malignancy 5