STEATOMA

Synonyms.—Sebaceous cyst; Sebaceous tumor; Atheroma; Wen; Fr., Stéatome;
Kyste sébacé; Athérome; Ger., Follikelcyste; Balggeschwulst; Atherom; Breigeschwulst;
Grützbeutel.

Definition.—A variously sized, elevated, rounded or semiglob-
ular, soft or firm, painless tumor, having its seat in the skin or sub­
cutaneous tissue.

Symptoms.—The favorite regions for the development of seba­
ceous cysts are the scalp, face, back, and scrotum. They are usually
of slow and insidious growth, often taking months to reach any con­
spicuous size. After attaining variable proportions, from a pea to that
of a walnut or larger, they may remain stationary. The overlying
skin is normal in color, or it may be whitish or pale from distention.
In some a gland-duct orifice is seen, but, as a rule, this is absent. In
the former, which is most commonly observed on the back and neck,
the tumor is somewhat flattened, often quite markedly so, spreading out
laterally rather than extending upward. In that in which the duct is
obliterated the formation is usually semiglobular or well rounded, and
often projects considerably above the skin level. A rounded growth
similar to this is sometimes observed in connection with the Meibomian
glands, and known as chalazion, although much smaller in size.

Sebaceous cysts may exist indefinitely without causing any dis­
comfort except their inconvenience and disfigurement. Exceptionally,
however, especially in the enormously distended growths, from irrita­
tion, traumatism, or some change in their contents, they become slightly
or moderately inflamed, the overlying skin reddens, and suppuration
and ulceration may result, and rarely such a lesion, in old people, may
finally show a papillomatous tendency and even epitheliomatous change.
In those in which the duct is not obliterated this at times may close up
temporarily, the tumor fill and become more prominent; later the orifice
opening again, and some of the contents finding egress, and the growth
flattening down somewhat; this may repeat itself from time to time. It

STEATOMA

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is usually from the smaller patulous sebaceous cysts that cutaneous horns
sometimes develop. The growths are, as a rule, of somewhat doughy
consistence, although with, in the more distended tumors, variable elas­
ticity; in some instances they are quite soft; in others distinctly hard.
They are often freely movable. The integument over the larger cysts
on hairy parts, especially the scalp, is commonly entirely devoid of hair.

In most cases but one tumor is present, although it is not at all
uncommon to see two or three. In exceptional instances—probably
mostly examples of multiple dermoid cysts¹—they have been present
in numbers, and generally scattered over the surface, and usually scarcely
distinguishable clinically from fibroma.

Etiology and Pathology.—The causes of sebaceous cysts are
not known, although thought to be due to the same agencies operable
in comedo, such as duct occlusion. Török and Chiari’s studies, made in­
dependently, have led them to believe that the majority, if not more,
of steatomata are more properly dermoid cysts, and arise from embryonic
remnants in the skin, as previously indicated by the investigations of
Heschl and Frank. Virchow, Robinson, and almost all others have
classed them with retention cysts, and this is the prevailing view to­day—
being cysts of the sebaceous glands. Winiwarter would include them
among cysto-adenomata, with primarily a new growth of gland tissue
and subsequent transformation into a cystic tumor. The growth con­
sists of a capsule and contents, the former composed of fibrous connective
tissue. The contents are found somewhat variable as to consistence
and substance; usually made up of a hard and friable, or cheesy and soft,
sometimes quite fluid, mass, of a whitish or yellowish color, and often
with a fetid odor. For the most part they contain sebum, epidermic cells,
cholesterin crystals, detritus and sometimes hairs,² and occasionally
lime-salts.

Diagnosis.—A sebaceous cyst is usually readily recognized
when its course, slow growth, and other features are considered. Those
with patulous ducts through which some of the contents can be squeezed
out scarcely admit of difficulty. The closed cyst is not to be confused
with lipoma, fibroma, and gumma. The lobular character of the fatty
tumor will generally serve to differentiate. The sites of fibromata are,
as a rule, different from those of sebaceous growths, and they are com­
monly multiple, whereas the latter are rarely present in greater number
than one or two, or, at the most, several. In those exceptional instances
—dermoid cysts—a microscopic examination may be necessary. Gum-
mata grow more rapidly, are usually painful to the touch, are not freely
movable, and tend to break down and ulcerate. Cold abscesses can
scarcely be confounded with steatomata, although those instances of the

¹ Jamieson, Edinburgh Med. Jour., Sept., 1873, p. 223 (250 tumors); Maclaren,
Edinburgh Med.-Chir. Soc’y Trans. (1886-87), 1888, p. 77 (132 tumors); Chiari, Zeit-
schrift für Heilkunde, 1891, vol. xii, p. 189, also met with an instance in which several
hundred were scattered over the entire surface; Pollitzer, Jour. Cutan. Dis., 1891, p.
281 (150; many yellowish and simulating multiple xanthoma in appearance).

² In a case under my observation (reported in Philada. Med. Times, March, 24,
1885) the cyst, on the bearded part, contained a coil of hair which, when unwound, was
found to consist of two hairs, one 6 inches in length and the other 4½ inches.

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DISEASES OF THE APPENDAGES

latter which become inflamed and suppurate bear some suggestive re­
semblance. The sebaceous tumors should not be confused with the
growths of molluscum contagiosum.

Prognosis and Treatment.—The only consequences of the
presence of sebaceous cysts are the inconvenience and disfigurement.
They are benign formations, but show no tendency to spontaneous dis­
appearance.

The treatment of the tumor is by surgical methods. A linear incision
is made, and the mass and enveloping sac are dissected out. If the latter
remain, a regrowth almost invariably takes place. Other plans have
occasionally been resorted to, such as slight incision, expulsion of the
contents by pressure, and the injection of some irritating fluid, such as
tincture of iodin or silver nitrate solution. Caustic destruction has also
had some use, but the best and safest plan is that by excision. In small
or beginning tumors a slight incision and expulsion of the contents,
and then the application, at several points of the cavity, of the electric
needle (electrolysis), will sometimes suffice to bring about permanent
removal.

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