These arise from just under the surface of the skin and are often related to a penetrating injury to the skin. Often there is displacement of the top layer of skin (epidermis) to deeper layer. Skin cells naturally produce a waxy substance called keratin and often a central keratin punctum can be seen. They are often asymptomatic, slow-growing, firm and round. Foreign bodies, such as splinters may also cause a reaction that forms a lump in the hand in a similar fashion to an epidermal cyst.
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