Q: Dr. Eppley, I am a 40 year old female in good health and I have a 7mm epidermoid cyst on my forehead, just above my right eyebrow. I had an ultrasound scan which shows that it is quite deep near the skull. The report states that it is a benign looking 7mm cyst which looks subgaleal and is located in the region of the right glabella. However it is having an effect on my self-esteem and I would like to know what options I have for removal and whether a direct excision would be the best and safest option or to if it is worth getting it removed by endoscopic surgery?
In particular I am worried about what the scar will be like if I get it removed directly since I am of Asian origin and am I am concerned about the scarring. I am exploring whether having it removed endoscopically would be worth-while given my concerns over scarring.
Because my cyst is located further down near the eyebrow would this be more of a risk and more difficult to remove by endoscopic surgery? By doing an endoscopic surgery would this cause an indent or depression where the cyst was removed?
Would the benefits outweigh the risks and would there be any risks of a depression at the location after the endoscopic removal?
I would be interested in hearing your views about this and whether this is an option worth exploring. I would greatly appreciate your feedback.
A: Dermoid cysts are exceedingly common around the eye area and are often located down at the bone level. In many cases, they will even leave a little depression in the bone. While an endoscopic approach would be preferable from a scar standpoint, the question is whether this approach can technically be done given how low it is on the forehead. I can not really comment on this technical aspect without seeing a picture of where it is on the glabella region. Most likely it can be removed endoscopically having done it this way myself numerous times.
Whether its removal will leave a depression can not be predicted. But given its relatively small size, I suspect it may not. But you can always hedge that bet by placing a small fat graft in its place at the same time.
Dr. Barry Eppley