Preauricular Epidermoid Cyst and it’s Surgical Management: A Rare Case Report

Preauricular epidermoid (keratinous) cysts are uncommon benign lesions that clinically resemble inflammatory or infectious conditions, such as abscesses, salivary gland pathology, or congenital sinuses, often resulting in misdiagnosis and delayed treatment. Early recognition is critical to prevent complications and unnecessary interventions. Hereby, the authors present a rare case of a 23-year-old male who developed a progressively enlarging swelling in the preauricular region, which acutely became painful, erythematous, and tender, with a central punctum discharging keratinous material. Although the clinical features initially suggested an abscess, the superficial location, absence of a sinus tract, and characteristic cyst contents raised suspicion of an infected epidermoid cyst. The patient was treated with antibiotics to control infection, followed by complete surgical excision under local anaesthesia. Intraoperative findings revealed a cystic mass containing laminated keratin debris, and histopathological examination confirmed the diagnosis of an epidermoid cyst lined by stratified squamous epithelium. The postoperative course was uneventful, with no recurrence at 12-month follow-up. Reporting present case is important due to the rarity of preauricular localisation and its clinical mimicry of other pathologies, particularly parotid abscesses and branchial cleft anomalies, which can lead to inappropriate management. The present case highlights the significance of considering epidermoid cysts in the differential diagnosis of preauricular swellings and reinforces that infection control followed by complete excision of the intact cyst capsule is crucial for optimal outcomes. Awareness of this entity may guide clinicians toward timely diagnosis, prevent recurrence, and avoid unnecessary imaging or invasive procedures.