Dermoid and Epidermoid Tumors and Cysts

Overview
Diagnosis
Treatment

What are Dermoid and Epidermoid Tumors?

Dermoid tumors are inclusion cysts. This means they are caused by the implantation of epithelial tissue into another structure. A dermoid tumor will most frequently occur on the face, inside the skull, on the lower back, and in the ovaries. More rarely, dermoid tumors can arise in the brain, nasal sinuses, and spinal cord.

Dermoid cysts are bizarre in that they contain developmentally mature skin, complete with sweat glands, hair follicles, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat, bone and cartilage, nails and teeth, and thyroid tissue.

Because they contain mature tissue, these cysts are almost always benign (noncancerous). Usually solitary, they expand slowly over many years due to the central accumulation of epithelial debris and glandular secretions. These cysts are not tender unless they rupture.

Epidermoid tumors are similar in structure and origin to dermoid tumors and the two are often grouped together. Epidermoid tumors are lined with stratified squamous epithelium (skin) as dermoids are, but do not contain the additional skin appendages. Epidermoid cysts are less likely to rupture.

Dermoid and epidermoid tumor symptoms are associated with the location of the tumor and the effect of its mass on adjacent tissues. When dermoid and epidermoid tumors are found on the brain, the symptoms can include pain and vision problems.

At UPMC, the preferred surgical treatment for dermoid and epidermoid tumors in the base of the skull or upper spine is the Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. Benefits of EEA include:

No incisions to heal
No disfigurement
Faster recovery time

For dermoid and epidermoid cysts within the substance of the brain, the preferred surgical treatment at UPMC is Neuroendoport® surgery. Neuroendoport surgery gives surgeons access to dermoid and epidermoid tumors through a dime-size channel. This minimally invasive removal approach offers benefits such as:

Minimal scarring
Fewer side effects and complications
Faster recovery times than with traditional surgery

Diagnosing a Dermoid or Epidermoid Tumor

To diagnose a dermoid or epidermoid tumor, your doctor will:

Perform a physical exam.
Ask you about your symptoms.
Order imaging tests.

Symptoms of dermoid and epidermoid tumors

Symptoms depend on the tumor's location and whether it is intact or has ruptured. Common symptoms include pain and vision problems.

Location of the cyst	Symptoms or complications
Above the base of the skull (suprasellar)	Vision problems from compression of the optic chiasm. Disruption of pituitary function, resulting in a hormonal imbalance. Seizures may result from tumors that extend to the temporal lobe and lateral sulcus (Sylvian fissure).
Within the fluid-filled spaces of the brain (intraventricular)	Hydrocephalus, which is excessive accumulation of cerebrospinal fluid in the ventricles of the brain. This excessive fluid results in enlargement of the head and causes many neurologic complications.
Spinal canal	Back pain. Leg pain.

Imaging tests for diagnosing dermoid and epidermoid tumors

Imaging studies, such as MRI or CT scans, will help the doctor locate the dermoid or epidermoid tumor.

An MRI scan does a better job at finding intracranial or intramedullary cysts because it depicts their location and involvement of other structures.

MRIs also are more sensitive in determining if the cyst has ruptured.

Dermoid and Epidermoid Tumor Treatment and Surgical Options

Surgery

Surgery to remove the cysts is the recommended treatment.

During dermoid tumor removal surgery, our experts take extreme care to prevent the fatty content of the cyst from spreading to the surrounding tissues or anatomic structures, especially if the cyst is infected with bacteria. The spread of these contents can cause foreign body reactions and severe complications.

Minimally invasive surgery

The type of surgery used to remove dermoid and epidermoid tumors depends upon their location.

Dermoid and epidermoid cysts of the skull base may be approached directly using the Endoscopic Endonasal Approach (EEA). This state-of-the-art, minimally invasive surgery approach allows surgeons to access the tumor through the natural corridor of the nose, without making an open incision. Surgeons then remove the cyst through the nose and nasal cavities.

EEA offers the benefits of no incisions to heal, no disfigurement, and a faster recovery time.

Neuroendoport® surgery offers a minimally invasive option for tumors within the ventricles (fluid spaces) or deep-seated tumors within the substance of the brain. A narrow tube or port allows surgeons to access these tumors through a tiny incision in the scalp, in contrast to traditional brain surgery.

Endoscopic Endonasal Approach (EEA)
Pituitary Tumor Removal Using the Endoscopic Endonasal Approach (EEA) at UPMC

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