Introduction

Several dermatosis are encountered in day to day surgical practice. The pathology vary from benign to malignant one, but very often benign cutaneous lesions are encountered.A sebaceous cyst of scalp is uncommon entity. Neglect on the part of patient sometimes leads to giant sebaceous cyst formation rarely encountered. These giant sebaceous cysts are more prone for developing malignancy

Case Presentation

A 60 year old male presented with two painless swellings on scalp of 15 years duration. Both of the swellings increased progressively in size and there was no positive history of trauma or infection. General and systemic examination was within normal limits. Local examination of two swellings revealed larger one 7.3× 6.9×2.4 cm, second one being 6.1×5×2 cm,in dimensions, nontender ,fixed to underlying skin but freely mobilefrom underlying structures(Fig.1)

Figure 1

Figure showing two large sebaceous cysts on scalp

No neck lymphadenopathy was present, Excision of these giant sebaceous cysts was done.Histopathological examination was consistent with epidermoid cysts

Discussion

Giant sebaceous cysts are rare entity in clinical practice₁ Sebaceous cysts are presently called as epidermoid cysts .These asymptomatic, dome-shaped lesions are painless smooth skin lump with thick yellowy sebum in the lump . Cysts usually vary in size from 1cm to 4cm in diameter. Most of times often arise from a ruptured pilosebaceous follicle. Multiple epidermoid cysts are associated with lipomas or fibromas of the skin and osteomas and should be considered as part of Gardner's syndrome, with associated premalignant colonic polyps. Pathologically, epidermoid cysts are lined by a cornified epithelium with a distinct granular layer. It contains a lamellated keratin without calcificication . Some cysts can be associated with basal cell and squamous cell carcinoma.In long standing cases in elderly ,squamous cell carcinoma arises from this type of cyst . Bowen disease, metastatic carcinoma, Merkel cell carcinoma, and mycosis fungoides have all been reported in association with epidermoid cyst.Differential diagnosis includes milia,Pilar cysts nevoid basal cell carcinoma syndrome ,pachynychia congenital,lipomas , dermoid cyst.Treatment is excision of cyst.

Correspondence to

Imtiaz Wani Post Graduate Scholar Shodi Gali ,Amira Kadal , Srinagar , Kashmir,India 190009 Email: imtazwani@yahoo.com Cell.No.9419904864