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An epidermal cyst is one of the most common benign tumors of the skin and its major treatment method is excision. Surgical excision is treatment of choice for epidermal cysts, but the cyst wall may be ruptured during operation, especially when the cyst wall is relatively thin. The incomplete excision of the cyst sometimes occurs because of a rupture of the cyst and incomplete excision may cause recurrence. The purpose of this study is to evaluate the factors that can influence the thickness of the cyst wall of epidermal cysts.From December 2008 to November 2013, medical records and tissue pathology slides of 290 patients with an epidermal cyst were reviewed retrospectively. The relationships among the regions, history of infection, the age of patients, and the thickness of the cyst and epidermis were analyzed.There was no difference between thickness of cyst wall and site of occurrence and between thickness of epidermis and site of occurrence. The thickness of epidermal cyst wall with previous infection is thicker than those without infection episode (P = 0.01). However, the difference of thickness of epidermis above the cyst between with and without previous infection is not statistically significant (P = 0.641). The thickness of cyst wall and epidermis showed positive correlation (Pearson correlation coefficient 0.391, P = 0.01).From this study, there was a tendency cyst wall with the history of infection or incision and drainage is thicker. When surgical excision, more attention to excise epidermal cyst completely is needed for the prevention of recurrence of the cyst.