<![CDATA[Abstract Introduction Epidermal inclusion cysts (EIC) of bone are rare, most commonly affecting the distal phalanx. Typically associated with trauma, they present as lytic expansile lesions, often mimicking other bony pathologies. Case report We report a 35-year-old male with a progressively enlarging swelling of the right little finger, following repeated blunt trauma. MRI revealed a well-defined lytic expansile lesion in the subungual region, suggestive of an EIC. FNAC was inconclusive, and a histopathological biopsy examination confirmed keratin flakes, consistent with EIC. Discussion EICs appear as radiolucent lytic lesions on X-rays, often confused with chronic infections, enchondromas, simple bone cysts, aneurysmal bone cysts, giant cell lesions, and malignant tumors. Accurate diagnosis relies on histopathology, which identifies EICs by keratin-filled cystic spaces lined with squamous epithelium. Conclusion Treatment typically involves curettage and removal of keratotic debris, underscoring the importance of precise diagnosis to avoid unnecessary interventions. This case highlights the necessity of including EICs in the differential diagnosis of radiolucent bony lesions to ensure appropriate management. Keywords- Epidermal Inclusion Cyst, Bone Cysts, Distal Phalanx, Lytic Bone Lesions, Intraosseous Epidermal Inclusion Cyst]]>
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