Epidermal Cyst Characteristics Analysis

Epidermal (epidermoid) cysts are the most common cutaneous cysts, arising from the infundibular portion of the hair follicle. Let us examine each statement carefully.

• Statement 1: It is lined by stratified squamous epithelium — True.

  The wall of an epidermal cyst is composed of stratified squamous epithelium with a well-formed granular layer, identical in structure to normal epidermis, which produces the keratinous (cheesy) material filling the cyst.

• Statement 2: It is derived from hair follicle — True.

  Epidermal cysts develop from the infundibulum (upper part) of the hair follicle, either due to occlusion of the follicular orifice or traumatic implantation of epidermal elements into the dermis.

• Statement 3: It is also called sebaceous cyst — True (in conventional/clinical usage).

  Although the term is a histological misnomer — the cyst arises from follicular epithelium, not from sebaceous glands, and does not contain sebum — epidermal cysts are traditionally and very commonly referred to as "sebaceous cysts" in standard clinical and surgical textbooks (e.g., Bailey & Love). For the purpose of this question, this popular synonym is treated as an accepted true statement.

• Statement 4: It is not fixed to the skin — False.

  A characteristic clinical feature of an epidermal cyst is that it is fixed to the overlying skin (because it originates from the epidermis/follicular infundibulum), often with a visible central punctum, while remaining mobile over deeper structures. This is a key clinical sign used to distinguish it from other subcutaneous swellings such as a lipoma, which is free from the skin. Hence, describing it as "not fixed to the skin" is incorrect.

Correct Combination Identification

Statements 1, 2, and 3 are true, while statement 4 is false. Therefore, the correct answer is option "1, 2 and 3".