Epidermoid cysts results due to implantation of epidermis tissue in dermis or subcutaneous tissue. It may be congenital or
iatrogenic. We present here two rare sites with rare presentation. The meticulous surgical excision is curative.
A 12-year-old boy follow up case of sub-coronal hypospadias,
operated at one year of age with Snodgrass urethroplasty, presented
with small penile swellings for last one year. On examination, penis
was normal with neo-meatus at glans and passing urine in single
good stream and evidence of two small swellings less than 1 cm
size on ventral and right lateral shaft which were non tender, nonfluctuant
and slightly mobile (Figure 1). Under mask ventilation,
two epidermoid cysts were excised (Figure 2) and histopathology
A 13-year-old boy presented with a large swelling over glans
and dorsal penile shaft for 2 years (Figures 3 & 4). It was excised
and sent for histopathological examination, which revealed it to be
The epidermoid cyst per se may occur anywhere in human
body but primary epidermoid cyst of penis is a rare occurrence.
The usual location of epidermoid cyst is in the midline or the sites
of bony fusion. They may occur secondary to inclusion of epidermis
at the sites of bony or iatrogenic closure, so also called epidermoid
inclusion cysts. It occurs secondary to proliferation of trapped or
sequestered epidermal tissue, causing subcutaneous firm and
mobile swellings. The penile epidermoid cysts are usually reported
in older age group. The literature reports that median raphe cysts
are result of faulty embryological development in males . Both
of our cases had cysts away from median raphe, raising possibility
of idiopathic cause. It is very difficult to label epidermoid cyst in
case 1 as primary or secondary as though it was post urethroplasty,
it appeared 10 years after surgery and also was away from neourethra.
The idiopathic form of penile epidermoid cyst is also
reported in literature in a young child .
The physical examination is all that is needed for diagnosis.
Rarely, radiological assessment with ultrasound may be sought.
The differential diagnosis may include steatocystomas or rarely
teratoma. Khanna S reported first case of glans epidermoid from
India in 1991 . The meticulous surgical excision is treatment
of choice. Care should be taken to avoid rupture of capsule of
cyst to avoid recurrence. Histologic examination confirms the
diagnosis, with cyst showing keratinized stratified squamous
epithelium containing sebaceous or pultaceous material. Erikci
VS et al reported first case of epidermoid cyst in an operated case
of hypospadias at the age of 5 years (after 4 years of surgery) .
Our case 1 is probably the second case such reported and first with
such late presentation post hypospadias surgery (after 10 years)
and without any other complications.