Histopathological Spectrum of Clinically Diagnosed Epidermoid Cyst: A Series of 20 Cases

Epidermoid cysts are among the most common subcutaneous nodular lesions encountered in clinical practice and are often diagnosed clinically. However, a wide spectrum of benign and malignant cutaneous adnexal and soft-tissue tumours can closely mimic these lesions, posing significant diagnostic challenges. The present retrospective case series was conducted at a tertiary care hospital over a one-year period (January–December 2025) to evaluate the histopathological spectrum of lesions clinically diagnosed as epidermoid cysts. A total of 20 cases (12 males and eight females) were analysed. Clinical details were recorded and all excised specimens underwent histopathological examination. The majority of cases showed clinicopathological discordance. Skin adnexal tumours were the most frequent mimickers (11 cases), including nodular hidradenoma (n=5), pilomatricoma (n=3), eccrine spiradenoma (n=1), chondroid syringoma (n=1) and pilomatrix carcinoma (n=1). Peripheral nerve sheath tumours were identified in four cases. Other diagnoses included basal cell carcinoma (n=1), calcinosis (n=1), dermoid cyst (n=1), ganglion cyst (n=1) and papillary cystadenoma (n=1). Two cases were malignant. The present study highlights significant clinicopathological discordance and the risk of missed malignancies in clinically suspected epidermoid cysts. Histopathological examination {Haematoxylin and Eosin (H&E)} remains essential for definitive diagnosis and a multidisciplinary approach is critical for appropriate patient management.