Epidermal inclusion and dermoid cyst are slow-growing nonmalignant painless lesions Cysts or congenital lesions that are superinfected are often treated with incision and drainage followed by antibiotic therapy Complete excision may be performed when the acute infection has resolved Epidermal Inclusion Cyst Among the most common postpubescent skin lesions is the epidermal inclusion cyst (EIC) These have also been termed epithelial, sebaceous (incorrectly named), and pilar cysts EICs are acquired lesions and result from occlusion of pilosebaceous follicles, although some stem from inoculation of epidermal cells into the dermis via needlestick or other trauma A few may arise from epidermal cells that become trapped along embryonic lines of closure Lesions consist of firm, slow-growing round nodules that can range in size from a few millimeters to centimeters Most are solitary lesions found about the scalp and face, although they also may be located on the trunk, neck, and scrotum Histologically, these dermal and subcutaneous nodules consist of epidermally lined keratin-filled cysts Presentation is that of a slow-growing painless lump that may provoke concerns of malignancy A central punctum is frequently present, but not required for the diagnosis Diagnosis is made clinically At times, these cysts become acutely infected, and the patient complains of pain, erythema, and sudden increase in size Infected cysts should be incised and drained, as well as treated with oral antibiotics before elective excision Noninflamed cysts can be referred for elective excision that must include the entire sac to prevent recurrence In the rare case of children with multiple large EICs, Gardner syndrome should be suspected This autosomal dominant disorder is characterized by multiple EICs, intestinal polyposis, desmoid tumors, and osseous lesions Early diagnosis is especially important because of a 50% risk of malignant transformation of the intestinal polyps Referral to a gastroenterologist and geneticist should be considered in these patients Dermoid Cyst Dermoid cysts are congenital, subcutaneous nodules derived from ectoderm and mesoderm They occur with a male predominance Like EIC’s, dermoids are lined with epithelium However, they can be distinguished by their younger age distribution, location and histologically by the possible presence of hair, glands, teeth, bone, and neural tissue, as well as keratin The cysts usually present as