A cyst is a closed sac under the skin that contains fluid or semi-solid material. Head cysts are common, benign growths that present as a lump beneath the skin. They may be removed for cosmetic reasons, discomfort, or due to a risk of infection. While a primary care physician (PCP) can offer an initial diagnosis, the actual removal of a head cyst is typically performed by specialists trained in minor surgical procedures and wound closure.
Identifying Common Head Cysts
Two types of cysts are most frequently found on the scalp and head: Epidermoid and Pilar cysts. Epidermoid cysts form when epidermal cells, which normally shed from the skin’s surface, become trapped beneath the skin, often as a result of trauma or a blocked hair follicle. These trapped cells continue to produce keratin, a thick, cheesy substance. Epidermoid cysts can occur anywhere on the body but are commonly seen on the face and neck. Pilar cysts are the most common type found specifically on the scalp. They originate from the root sheath of the hair follicle, and it is common for several to appear simultaneously on the head. Both types present as firm, dome-shaped lumps that grow slowly and are generally painless unless they become inflamed or infected.
Primary Medical Professionals for Removal
The initial diagnosis of a head cyst may occur during a routine visit with a primary care physician, but the majority of removals are performed by specialists. Dermatologists are the most frequent practitioners for the removal of routine, superficial head and scalp cysts. Their specialized training in skin conditions and minor surgery makes them well-equipped to perform excisions in an outpatient setting. Plastic surgeons are often involved when a cyst is particularly large, located on the face or another highly visible area, or when the goal is to minimize the resulting scar. These specialists utilize advanced closure techniques, sometimes hiding incisions within the hairline or natural skin creases to achieve the best aesthetic outcome. The involvement of a neurosurgeon or a maxillofacial surgeon is reserved for rare and complex cases, such as congenital dermoid cysts that extend deep into the skull bone or those connected to intracranial structures. A detailed imaging scan, such as an MRI or CT scan, is required in these instances to determine the cyst’s full depth and proximity to critical tissues.
The Removal Procedure Explained
The gold standard for permanent cyst resolution is complete surgical excision, which aims to remove the entire cyst wall or sac to prevent recurrence. The procedure is typically performed in an office or outpatient setting under local anesthesia, which is injected around the cyst to numb the area. The medical professional then makes a small incision, which allows for careful dissection of the entire cyst capsule from the surrounding tissue. Removing the sac intact is important because leaving even small fragments of the cyst lining behind can cause the lump to regrow.
For smaller, uncomplicated cysts, some practitioners may use a minimally invasive technique, such as a punch biopsy tool, to create a tiny opening through which the cyst contents and sac can be extracted. Once the cyst is removed, the wound is closed using fine sutures, which may be absorbable or require removal after about one to two weeks.
The entire procedure usually takes less than an hour, and patients are typically able to return home immediately afterward. Post-operative care involves keeping the surgical site clean and dry, monitoring for signs of infection like increasing redness or pain, and limiting strenuous activities for a short period. Specific instructions are given for scalp excisions regarding hair washing and gentle grooming to protect the healing incision.
Factors Determining the Approach to Treatment
The decision to remove a head cyst and the technique selected depend on several factors beyond its simple presence. Cysts that are acutely infected, presenting with significant redness, swelling, and pain, are not typically removed right away. Instead, initial treatment involves a procedure called incision and drainage (I&D) to relieve the pressure and clear the infection, with complete excision delayed until the inflammation subsides.
The cyst’s size and location also influence the treatment strategy, as large cysts or those near delicate structures may require more specialized surgical planning. Furthermore, after the cyst is removed, the tissue is sent to a pathology lab for histopathological analysis. This examination confirms the type of cyst and ensures that no rare, abnormal cells are present, which is an important step to rule out the possibility of a more serious underlying condition.