Occurrence and Characteristics of Head Cysts in Children

Noam Armon, MD; Sivan Shamay, MD; Alexander Maly, MD; Alexander Margulis, MD

Disclosures

ePlasty. 2010;10:e37 

In This Article

Abstract and Introduction

Abstract

Background: Lumps arising in the head and neck constitute an important diagnostic category in children. As malignancy in this age group is relatively rare, lumps that are not due to inflammatory or infective causes often prove to be cysts. Correct diagnoses of the different subcutaneous lumps are often missed because of the lack of recognition or uncertainty with management.
Objectives: The purpose of this study was to review the characteristics of most common pediatric cysts appearing in the head.
Methods: A retrospective study was designed to review all the children treated for a cyst in the head during the 12-year period from 1995 to 2007. Study patients had a preoperative diagnosis of a cyst in the head, were younger than 11 years at the time of the diagnosis, and had received a surgical treatment for the condition. The pathological specimens were revised with an expert dermatopathologist, and the clinical data were statistically analyzed.
Results: Of the 90 cysts, 53 were dermoid cysts (58.88%), 16 were diagnosed as pilomatrixomas (17.77%), 5 cysts were diagnosed as branchial cysts (5.55%), and 12 were diagnosed as epidermal cyst (13.33%). Male gender and younger age were significantly associated with correct diagnosis of dermoid cysts (P <.05).
Conclusions: Ninety-five percent of the cysts fell in 1 of the 4 following categories: dermoid cyst, pilomatrixoma, epidermal cyst, and branchial arch cyst. Dermoid cysts were the most common facial cysts (60%). Correct preoperative diagnosis was more accurate in cases of dermoid and branchial cysts.

Introduction

Pediatric dermatologic complaints are a common cause of outpatient physician visits. From cysts and warts to birthmarks and vascular anomalies, primary care physicians recognize many "lumps and bumps" in childhood. Correct diagnoses of the different subcutaneous lumps are often missed because of the lack of recognition or referred to plastic surgery for a second opinion because of uncertainty with management. Entities such as dermoid cysts, pilomatrixoma, and branchial anomalies often fall into this category. Even though the clinical and pathologic diagnosis of these skin lesions in children is well described in the literature, it is common to see erroneous diagnoses of "sebaceous cyst" on small children and "pillar cysts" on coronal or lambdoid dermoid cysts.

A retrospective study was designed to review all the pediatric patients treated for a cyst in the head by the senior author (A.M.) at the Hadassah Medical Center in Jerusalem during the 12-year period from 1995 to 2007. Study patients had a preoperative diagnosis of a cyst in the head, were younger than 11 years at the time of diagnosis, and had received a surgical treatment for the condition. The pathological specimens were then revised with an expert dermatopathologist, and the clinical data were statistically analyzed in respect to the various types of cysts present in the study group. To better define the different types of pediatric cysts, we reviewed our experience with the presentation, diagnosis, and treatment of the different types of pediatric cysts of the head.

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