|
By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
|
|
|
CASE:
An 82-year-old man presents for evaluation and treatment of a slowly enlarging growth on the right side of his neck. He states that the growth is not tender but occasionally drains a foul-smelling, cheesy substance. Examination of the site reveals a 3 cm by 3 cm, freely movable dermal nodule. On closer inspection, a central pinpoint opening on the skin surface is noted. Pressure on the lesion results in expression of a malodorous, caulk-like material.
WHAT IS YOUR DIAGNOSIS?
|
| |
| |
|
|
|
This patient has an epidermoid cyst, an invagination of the skin characterized by the accumulation of cellular debris and keratin within an epithelial-lined sac. Over time, the material develops a pungent odor. These lesions are most commonly found on the back and chest but can arise on virtually any part of the body. Treatment utilizing incision and drainage will effectively shrink the lesion, but recurrence is common unless the entire wall is excised. Epidermoid cysts have no malignant potential. |
|
Dr. Schiffman is a dermatology resident
at St. John's Episcopal Hospital in Far Rockaway, New York.
Dr. Schleicher is director of DermDx Centers and a clinical
instructor
of
dermatology
at
the Philadelphia
College of
Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania,
and at Arcadia University in Glenside, Pennsylvania. He is
also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 38(6):51-2, 2006
|
|
