Dermoid Gallery Patient 891829

Before Surgery

Fergie was born with a small lump under the outer portion of her left eyebrow. The bump became more noticeable as she grew, prompting her family to seek an evaluation.

The lesion was diagnosed in the office by Dr. Lichtenstein as a probable orbital dermoid cyst, the most common benign orbital tumors seen in children.

Dermoid cysts develop very early in pregnancy, while the bones of the face and eye socket are forming. As these structures come together, a tiny fragment of skin can become trapped beneath the surface. The trapped skin forms the lining of the cyst and produces normal skin products, such as oils and skin cells, which is why the cyst grows slowly over time.

Parents are often surprised to learn that these cysts are present from birth, as they may not become obvious until months or years later.

Why Treat a Dermoid Cyst?

Dermoid cysts are benign and do not become cancerous. However, they typically enlarge slowly and do not disappear on their own.

As they grow, they can become increasingly visible and may alter the natural contour of the brow, socket, or upper eyelid. In addition, trauma can cause a cyst to rupture, resulting in inflammation and irregular scarring under the skin,  and making later surgery more complicated.

For these reasons, surgical excision (removal) is often recommended once the diagnosis is confirmed.  The other benefit of excision is having a definite diagnosis.

Surgery

Fergie underwent a brief outpatient procedure to remove the cyst.

The dermoid was excised through an incision hidden within the natural crease of the upper eyelid. This approach, when feasible, allows excellent access to the cyst and helps to hide the scar.

The cyst was removed completely, sent to pathology (where the diagnosis was confirmed), and the surgery was completed without complication.

After Surgery

The postoperative photograph demonstrates restoration of the natural contour of the left brow. The prominence caused by the dermoid cyst has resolved, and the incision is concealed within the eyelid crease.

Most children recover quickly from dermoid surgery and return to normal activities shortly afterward.

The Goal of Treatment

The goal of surgery is complete removal of the cyst while preserving a natural appearance.

Fergie's result shows one of the advantages of the eyelid-crease approach: effective excision of the dermoid cyst with little visible evidence of surgery and a normal appearance of the brow and eyelid region.