Epidermal Cysts

The puncta, with a black center, clearly identified these as classic epidermal cysts.

A 67-year-old man with a history of non-melanoma skin cancer presented for a total body skin check. Two symptomatic nodules were discovered on his back.

Key point: Several 4-cm2 freely movable nodules were located on the central and right upper back. The differential diagnosis in this situation usually consists of epidermal cyst, lipoma, and cutaneous metastases. These are classic epidermal cysts.

Treatment: The treatment of choice would be simple excision. However, the patient was not interested in pursuing this option.

Note: The puncta, with a black center, present in both lesions clearly identified these as epidermal cysts. The “black” actually represents melanin produced by melanocytes located in the cyst wall.