A sebaceous cyst is a term used to describe a small, slow-growing lump beneath the skin’s surface. Although the name suggests an origin in the oil-producing sebaceous glands, most of these growths are actually a different type of skin cyst. These cysts are generally benign, but they can become inflamed, infected, or cause cosmetic concern, leading people to seek removal. Understanding who is qualified to perform the procedure and the available techniques provides clarity for those considering treatment.
Identifying the Type of Skin Cyst
The common term “sebaceous cyst” is often a misnomer for what doctors identify as an epidermoid cyst. Epidermoid cysts are the most frequent type of cutaneous cyst, arising from trapped epidermal cells that make up the skin’s surface layer. These cells shed inside the capsule, filling the cyst with a thick, cheese-like substance called keratin.
True sebaceous cysts are far less common and originate from the sebaceous glands, which produce the skin’s natural oil (sebum). These rare cysts are filled with oily, yellowish sebum, rather than keratin. Because most removals address the more prevalent epidermoid cyst, medical professionals encourage using precise terminology for appropriate diagnosis. Epidermoid cysts typically appear on the face, neck, and trunk.
Medical Professionals Qualified for Removal
Several types of medical professionals are qualified to perform skin cyst removal, depending on the cyst’s size, location, and complexity. Primary care physicians (PCPs), including family doctors, often manage small, uncomplicated cysts and can perform simple incision and drainage procedures in their office. They serve as the first point of contact for evaluation. If the cyst is large, recurrent, or located in a cosmetically sensitive area, a specialist is recommended.
Dermatologists are specialists in skin conditions and are the most commonly consulted experts for cyst diagnosis and removal. Their training in surgical dermatology makes them proficient in excision techniques designed to minimize scarring. They are skilled at managing cysts on the face, scalp, and neck where aesthetic outcomes are important. For very large, deep, or complicated cysts, such as those that have formed an extensive abscess, a general surgeon may be consulted.
Determining When Removal is Necessary
A small, asymptomatic skin cyst that does not cause discomfort often does not require removal and may simply be monitored. Intervention is indicated when the cyst becomes inflamed, infected, or ruptures, leading to pain, redness, and swelling. An acutely inflamed cyst may first require a temporary drainage procedure to resolve the infection before a complete removal is scheduled later.
Removal is also considered for cosmetic reasons, especially if the cyst is prominent or located on a visible body part. Excision is also valid if the cyst interferes with daily function, such as being irritated by clothing or causing discomfort when sitting. Though rare, a biopsy may be needed if the lesion has atypical features, to definitively rule out malignancy. Self-removal or squeezing should be avoided, as this can cause the cyst to rupture internally, leading to significant inflammation and a higher risk of infection.
Overview of Removal Procedures
Once the decision for removal is made, several procedural options exist, all performed under local anesthesia. The goal of any technique is to excise the entire cyst wall, or sac, because leaving any portion behind significantly increases the likelihood of recurrence. The conventional wide excision involves making an elliptical incision around the cyst to remove the entire structure intact. This method is often used for larger cysts and provides the best assurance against recurrence but results in a longer scar.
A popular alternative is the minimal excision technique, which uses a much smaller incision, sometimes via a punch biopsy tool. Through this small opening, the contents are expressed, and the collapsed cyst wall is carefully extracted. This method is favored for cosmetically sensitive areas because it leaves a smaller scar. When a cyst is acutely infected or abscessed, an incision and drainage (I&D) procedure is performed to release the pus and alleviate pain. Because the cyst wall is left in place during an I&D, this method carries the highest risk of recurrence, and a full excision is often needed once the inflammation subsides.