A sebaceous cyst is a common, non-cancerous lump that forms just beneath the surface of the skin. Although widely used, most of these growths are technically epidermoid cysts, resulting from trapped epidermal cells that multiply rather than shedding. They contain a thick, cheese-like material called keratin, not the oily sebum originally believed. These cysts are usually slow-growing and painless, but removal is often sought for cosmetic reasons or when the cyst causes discomfort or becomes inflamed.
Identification and When to Seek Help
A typical cyst appears as a smooth, round lump that is freely movable beneath the skin’s surface. It may be flesh-colored or slightly yellowish and can vary in size from a small pea to several centimeters. Some cysts exhibit a small, dark opening in the center, known as a punctum, which is a key identifying characteristic.
While most cysts are benign and can be monitored, certain signs indicate the need for prompt medical evaluation. Seek care if the cyst becomes noticeably red, warm to the touch, or increasingly painful. These symptoms suggest the cyst has become inflamed or infected, potentially leading to an abscess. Rapid growth, the discharge of foul-smelling pus, or a cyst located in an area of constant friction also warrant professional assessment.
Determining the Right Specialist
The choice of healthcare provider for removal depends primarily on the cyst’s size, location, and condition.
Primary Care Physician (PCP)
A Primary Care Physician (PCP) or General Practitioner (GP) is often the first point of contact and can manage simple, small, non-infected cysts. They may perform an initial incision and drainage or a straightforward excision in an office setting.
Dermatologist
For cysts on visible areas, such as the face or neck, a Dermatologist is preferred because of their expertise in cosmetic outcomes and skin health. Dermatologists specialize in precise techniques that minimize scarring. They are also equipped to handle cysts that are inflamed or require a biopsy to rule out other skin conditions.
General Surgeon
A General Surgeon is consulted for very large, deep, or complex cases, including recurrent cysts or those requiring a hospital-based procedure. The decision to refer to a surgeon is based on the technical difficulty of the removal, especially if the cyst is adhered to underlying tissue or has developed into a significant abscess.
Overview of Removal Procedures
Surgical removal is the only way to ensure the cyst does not return, and all procedures are performed under local anesthesia to numb the area.
Conventional Wide Excision
This is the most common approach, involving an incision slightly longer than the cyst’s diameter to remove the entire cyst wall or sac intact. This method offers the highest chance of a permanent cure but results in the longest linear scar.
Minimal Excision
To improve cosmetic results, providers may use Minimal Excision, especially on the face. This technique requires a much smaller incision, often just a few millimeters. The cyst contents are expressed, and the collapsed cyst sac is then meticulously removed. Although this leads to a smaller scar, ensuring the entire sac is removed is necessary to prevent recurrence.
Laser or Punch Biopsy Removal
This option is often used for draining infected cysts or for minimal scarring. It involves using a small circular blade or a CO2 laser to create a tiny opening, allowing the contents to be drained. The cyst wall can then be removed through this small hole. Alternatively, in a two-step process, the contents are drained first, and the collapsed sac is removed in a secondary procedure weeks later.
Aftercare and Reducing Recurrence
Following the procedure, the recovery period depends on the size and location of the removed cyst, typically lasting between two and four weeks for full healing. The patient will be given specific wound care instructions, usually involving keeping the incision clean and dry and changing the dressing. Stitches, if used, are generally removed within one to two weeks.
Patients should monitor the site for signs of complication, such as increasing pain, spreading redness, or thick, opaque discharge, which could indicate an infection. Recurrence is prevented by the complete removal of the cyst’s epithelial lining, or sac. If even a small piece of the sac remains, it can continue to produce keratin and cause the cyst to regrow.