This case report aims to present the clinical management of a large clitoral-labial epidermal inclusion cyst (EIC) in a 40-year-old multiparous woman with a history of childhood circumcision. EICs are benign, slow-growing cystic lesions typically arising from epidermal element entrapment within the dermis. Clitoral masses are rare, and their location often complicates diagnosis and management. This study aims to highlight the challenges and successful management of such a case, contributing to the body of knowledge surrounding vulvar cysts, particularly in patients with prior genital trauma.

A 40-year-old multiparous woman presented with a progressively enlarging clitoral-labial mass that she first noticed 10 years ago. The mass caused significant discomfort while wearing underwear, during menstruation, and pain during intercourse. The patient had a history of circumcision at 2 years of age, with no other significant medical history. Pelvic examination revealed a well-circumscribed, mobile, non-tender, cystic mass measuring 7x10 cm in the clitoral region, obstructing the urinary meatus and vaginal introitus. MRI imaging showed a 9.5 x 5 x 8.5 cm anterior vulvar cystic lesion, likely an epidermal inclusion cyst, with no solid components or communication with the urethra or vagina. The patient underwent clitoral and vulvar cystectomy with reconstruction of the labia and excision of redundant skin. The cystic mass was sent intact for histopathological examination.

The surgery was straightforward, with complete removal of the cyst. Histopathological analysis confirmed the diagnosis of an epidermal inclusion cyst. Postoperative follow-up was unremarkable, with no complications such as infection or recurrence. The patient reported significant relief of her symptoms, including improved comfort during menstruation and intercourse. The cosmetic outcome was satisfactory, and the patient was pleased with the surgical results.

This case highlights the effective management of a large clitoral-labial epidermal inclusion cyst in a patient with a history of childhood circumcision. The patient’s symptoms were successfully alleviated through surgical excision, and there were no significant postoperative complications. Although epidermal inclusion cysts are benign, their presence in the vulvar or clitoral region can have significant implications for a woman’s quality of life due to the discomfort and psychological distress they may cause. In this case, the patient experienced significant improvement in her symptoms following surgery, highlighting the role of surgical intervention in alleviating the physical and emotional burden associated with these lesions. The positive outcome supports the use of surgical excision as a reliable treatment for symptomatic clitoral-labial cysts, even in the context of prior genital trauma, such as circumcision. The MRI findings and histopathological results confirmed the diagnosis of an epidermal inclusion cyst, reinforcing the role of imaging and biopsy in ensuring accurate diagnosis and treatment planning

In conclusion, this case report illustrates the successful management of a large clitoral-labial epidermal inclusion cyst. The patient's clinical presentation, imaging findings, and histopathology confirmation underscore the importance of considering epidermal inclusion cysts in the differential diagnosis of vulvar masses, particularly in patients with a history of trauma or surgical procedures. Surgical excision remains the treatment of choice for symptomatic cysts, and complete removal of the cyst wall is essential to prevent recurrence.

1.	Victoria-Martínez AM, Cubells-Sánchez L, Martínez-Leborans L, Sánchez-Carazo JL, De Miquel VA. Vulvar epidermal inclusion cyst as a long-term complication of female genital mutilation. Indian Journal of Dermatology. 2016;61(1):119. doi:10.4103/0019-5154.174090
2.	Kanchan S, Garg A, Kyalakond K, Bhavana S. A Clitoral mass in postmenopausal women: a diagnostic dilemma. Authorea (Authorea). June 2023. doi:10.22541/au.168632634.49201490/v1
3.	Salem R, Ahmed S, Gupta P, Xiao Y, Morris M, Tiesenga F. Atypical presentation of epidermoid inclusion cyst in a 60-Year-Old female: a case report. Cureus. September 2022. doi:10.7759/cureus.29749