A cyst is a closed sac or capsule that can develop anywhere in the body, typically filled with fluid, semi-solid material, or air. These growths are extremely common, and the vast majority are benign, meaning they are not cancerous. While many cysts cause no symptoms and may disappear on their own, others can become inflamed, infected, or cause discomfort due to their size and location. The specific type and location of the cyst determine who can remove it and the method used.
Initial Medical Evaluation and Diagnosis
Cyst management begins with a primary care provider (PCP) or general practitioner. This initial physician serves a triage function, performing a physical examination and taking a detailed patient history to assess the nature of the lump. They determine if the cyst is superficial, like a skin lesion, or if it is an internal growth requiring specialized attention.
If the cyst is not easily identifiable, the PCP may order diagnostic procedures. Imaging techniques such as ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI) are used to determine the cyst’s size, exact location, and contents. In cases where there is concern about malignancy, a biopsy may be performed to analyze a tissue sample and confirm the diagnosis before removal.
Specialists Who Perform Cyst Removal
Dermatologists are the primary specialists for superficial cysts, managing common growths like epidermal inclusion cysts and pilar cysts, often in an outpatient office setting. These skin specialists are trained to remove the entire cyst wall, which is necessary to prevent recurrence.
General surgeons and specialized surgeons handle deeper and more complex cases within the torso and other organ systems. A general surgeon may excise larger, deeper cysts in soft tissue, the abdominal wall, or the breast. Cysts involving specific organ systems require specialized surgeons for definitive treatment.
Gynecologists manage ovarian cysts, sometimes using minimally invasive laparoscopic techniques. Orthopedic surgeons treat ganglion cysts, which are fluid-filled sacs near joints or tendons, most commonly in the wrist or foot. Highly complex cysts, such as those found in the brain, fall under the expertise of a neurosurgeon, who may use advanced techniques like endoscopic fenestration. Oral and maxillofacial surgeons manage cysts that develop within the jawbone or soft tissues of the mouth, requiring careful planning to preserve surrounding structures.
Common Techniques for Cyst Removal
The decision to remove a cyst is typically followed by selecting one of two main procedural approaches: aspiration or surgical excision. Aspiration is a minimally invasive technique where a fine needle is inserted into the cyst to drain the fluid contents. This method is often used for fluid-filled cysts, such as ganglion or breast cysts, and offers rapid relief with virtually no downtime.
A drawback of aspiration is that it often leaves the cyst wall intact, leading to a high rate of recurrence as the sac refills. Surgical excision is the definitive treatment for many cyst types, particularly those filled with semi-solid material or those that have repeatedly recurred. This procedure involves removing the entire cyst capsule and its contents, which significantly lowers the chance of the cyst returning.
Determining the Setting for the Procedure
The complexity of the procedure determines the setting for cyst removal. Small, superficial cysts, such as those treated by a dermatologist, are routinely removed in an outpatient clinic using only local anesthesia to numb the immediate area. This setting is appropriate for quick procedures that have a low risk of complications and do not require extensive monitoring.
If the cyst is large, deeply embedded, or located near a major organ or blood vessel, the procedure must be performed in a hospital or operating room (OR). Furthermore, the OR allows for the use of regional or general anesthesia and provides access to advanced surgical equipment and support staff. If malignancy is suspected, the controlled environment of the OR is required for the safest and most complete removal.