Steatocystoma Multiplex — SCE Dermatology MCQ

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ModerateSkin CancerSteatocystoma MultiplexSCE Dermatology

A 45-year-old man presents with grouped flesh-coloured papules on his neck. Biopsy shows dilated infundibular cysts lined by stratified squamous epithelium containing laminated keratin. Multiple lesions are present. What is the diagnosis?

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Correct answer: D — Epidermal cysts

The diagnosis is epidermal cysts (epidermoid/infundibular cysts). The decisive histology is a dilated follicular infundibular cyst lined by keratinising stratified squamous epithelium and filled with laminated keratin. Multiple epidermal cysts can occur, and the neck is a plausible site. The alternatives are excluded histologically: steatocystoma multiplex has a sebaceous-type cyst wall with sebaceous glands and oily contents; eruptive vellus hair cysts contain vellus hair shafts within the keratinous cyst; milia are tiny superficial keratin cysts rather than larger grouped infundibular cysts; and pilar cysts show trichilemmal keratinisation, usually lack a granular layer, and classically occur on the scalp.

Reference: StatPearls/NCBI Bookshelf. Epidermal Inclusion Cyst. Updated 2023. https://www.ncbi.nlm.nih.gov/books/NBK532310/