Perineal squamous cell carcinoma arising from an epidermal cyst: a case report

Abstract

Background: Epidermal cysts and squamous cell carcinomas (SCCs) are common skin lesions. However, a malignant change in an epidermal cyst is very rare. The incidence of a malignant change from an epidermal cyst to cutaneous SCC is 0.011-0.045%. In particular, malignant transformation of an epidermal cyst in the perineum is extremely rare. To date, three cases have been reported in the English literature.

Case presentation: We report a case of 51-year-old male with an approximately 15-cm perineal mass. This mass started to grow suddenly 4 months previously and caused great discomfort in the perineum due to the large size. The patient underwent excision of the mass with a negative margin. Histopathological analysis confirmed a microinvasive SCC arising from a proliferating epidermoid cyst.

Conclusions: Even if benign tumors are suspected, a change in size, pain, ulceration, or discharge should indicate the need for surgical resection due to the possibility of a malignant change.

Keywords: Epidermal cyst; Excision; Malignant transformation; Perineum; Squamous cell carcinoma.

Fig. 1

Gross findings in the operative field. An approximately 15-cm cystic mass is in the left perineal area near the anus

Fig. 2

Magnetic resonance imaging findings. The image shows a 6.7 × 16 cm lobulated mass in the medial aspect of the left perineum. a Transverse view. b Sagittal view

Fig. 3

Histopathological findings. a Gross findings: microinvasive squamous cell carcinoma (arrow), epidermal cyst wall (thin portion). b Microinvasive squamous cell carcinoma (H&E, × 400). c Benign cyst (H&E, × 1)