To understand what a sebaceous cyst is, we need to understand “What is a cyst?”
A cyst is a cavity filled with fluid, air, or semisolid substances resulting in abnormal growth of tissues on the body, generally a noncancerous growth in nature.
There are various classifications of malignant and non-malignant cysts. A few types of cysts related to the below discussion are:
- Pilar cysts
- Digital mucous cysts
- Epidermoid cysts
- Pilosebaceous cysts
- Cutaneous cysts
- Epidermal inclusion cyst
- Pilonidal cyst
- Bakers of popliteal cyst
- Mucous cyst
- Ganglion cyst
And the list goes on.
What are Sebaceous Cysts?
A sebaceous cyst is one among the types of cyst also known as epidermoid cyst, occurs due to obstruction to one of the sebaceous ducts in the sebaceous glands, resulting in accumulation of sebaceous material.
A sebaceous cyst is a good example of a retention cyst.
Where is a Sebaceous Cyst Commonly Located?
The common location sites of a sebaceous cyst are the scalp, face, back, behind the ears, scrotum, torso, to name a few.
Sebaceous cysts are noncancerous. A sebaceous cyst is caused due to damage to the sebaceous gland. These are the kind of cysts present under the skin. Sebaceous cysts vary from small to large sizes and appear as a lump or a bump on the skin surface.
These skin cysts are painless. Sebaceous cysts irritate the skin, however, but do not cause any serious complications.
What is Inside a Sebaceous Cyst?
Sebaceous cysts contain keratin-filled fluid caused by the disturbed hair follicle leading to excess protein accumulation. The infected cysts are usually harmless and require surgical removal, but the recurrence rate is high. Sebaceous cysts rarely become malignant.
A sebaceous cyst can affect any age group. It can be a genetic abnormality or even due to trauma of obstruction or destruction of sebaceous glands, which leads to the accumulation of sebum, and the duct is blocked.
Clinic Features of Sebaceous Cyst
- The epidermoid cyst or sebaceous cysts are slow-growing and appear in early adulthood or middle age.
- Sebaceous cysts are a hemispherical or spherical swelling located in the dermis
- Central keratin is filled with the punctum, a dark spot that helps in diagnostic features of the cyst. The punctum indicates blockage of the cyst.
- In about 30-40% of cases, instead of the duct opening into the skin, sebaceous ducts open into the hair follicles.
- Sebaceous cysts are usually smooth, with rounded edges and borders soft and putty in consistency, non-tender.
- Sebaceous cysts often display signs of molding.
- Signs of indentation can also be seen, which refers to pitting on pressure pressed over the swelling.
- The swelling is mobile and freely movable over the skin surface and deep structures but attached to the area of the punctum. The skin overlying the cyst in the scalp loses hair follicles because of the slow expansion of the cyst.
- Bony defects are absent, with skin fixed at the sight of the punctum, and intracranial communication is absent.
Symptoms of a Sebaceous Cyst
- Tenderness over the swelling
- Whitish-yellow lump on the body except for soles and palms
- Freely movable mass
- Local rise in temperature
- Redness and irritation over the skin surface
- Soft compressible mass
- The central opening of punctum
- Inflamed or infected area of concern
Associations With Sebaceous Cyst
- Syndrome – Gardener Syndrome
- Tumor – Cocks Peculiar Tumor
- Parasitic Worm – Demodex Folliculorum
What are the complications if the sebaceous cyst/epidermoid cyst is left untreated?
Since the sebaceous cyst is painless, it’s non-malignant. However, the cyst can be removed by sebaceous cyst excision. Complete removal of the cyst can be done with a conservative approach and minimal scarring; however, the chances of recurrence are high.
If the sebaceous cyst is left untreated, it may give rise to a few complications, and hence it is important to remove the cyst.
Following are a few complications that can occur because of sebaceous cysts:
1. Infection: The chances of infection increase if we do not remove the cyst. In many patients, it might result in injury or scratch, giving rise to an abscess. The cyst will be red and tender, and it should be treated by incision and drainage. After a few months, the cyst can be excised.
2. Sebaceous Horn: Results due to slow drying of the contents which are squeezed out. It’s not common to find a large sebaceous horn.
3. Risk of Calcifications.
4. Cocks Peculiar Tumor is an infected ulcerated scalp cyst with pouting granulation tissue with everted edges that resembles epithelioma.
5. On long-standing sebaceous cyst, sometimes it can give rise to basal cell carcinoma.
Treatment And Excision of the Cyst
It is important to remove cysts and empty the cyst contents to reduce inflammation.
- Incision and avulsion of the cyst within the wall. During dissection, the cyst wall ruptures, and hence care should be taken to excise the entire cyst wall and ensure that the thin-walled cysts are entirely removed.
- When the cyst is small, it can be excised along with the skin.
Surgical Intervention of the Sebaceous Cyst
Why is it important to remove the cyst?
There might be sudden increases, and the skin over the lump may become irritable, and hence excision of the cyst is the only permanent solution. Small cysts can be treated with antibiotic ointment.
The surgically removed cyst should ensure as small a scar as possible at the surgical site, with minimal scarring.
Nowadays, the process is painless with the advanced surgical technique, and the patient is discharged within 24-48 hours of admission.
Before proceeding to the surgery, a few tests have to be run, such as:
- CT Scan: It will help the operator analyze the cyst and its routes and structures aligned with it.
- Ultrasound: It helps the doctor find out the cyst content.
- Punch Biopsy should be taken by removing a small area of the tissue from the cystic site to examine in the laboratory for signs of any malignancy or its potential to develop skin cancer.
Among all the other minimal excision techniques, the 3 main techniques are conventional wide excision, minimal excision, and punch biopsy excision.
Now let us see how are these procedures carried out under local anesthetic solutions:
1. Conventional Wide Excision
Conventional wide excision can ensure the complete removal of the cyst and leaves a long ugly scar. Hence the combination of various techniques was tried to ensure minimal scarring.
A small hole or a passageway is made to empty the cyst contents of large cysts. Carbon dioxide lasers should be used to ensure aesthetic removal, bloodless surgery, and better healing of the surgical wound.
The size of the cyst should be measured, and the 4mm diameter of the incision should be made approximately to make sure that all the walls are included in the procedure.
Thin-walled cysts tend to have a discontinuity in the wall and break easily. To achieve the desired results, it should be handled with care, remove the cyst part by part, and empty the fluid by squeezing the site.
Remove the sebaceous cysts in a way to prevent a recurrence. After the contents are removed, the hard cyst should be scooped out, curated, and cleaned, the incision closed by suturing the area.
2. Minimal Excision Technique
The skin overlying the cyst is cleaned and anesthetized, most cysts are simple to excise, but few might be painful. The povidone-iodine solution is applied over the skin surface, and no. 11 blades are used to create a stab incision.
A gauze piece helps prevent spraying of the fluid and compress it. This is the easiest technique, but it might be behind wall pieces which can result in recurrence.
Removing sebaceous cysts on the scalp can be difficult due to the thick walls, but the cyst comes out intact later on antibiotic cream is prescribed. Sterilization and healthcare provider protection should be maintained throughout the procedure of the removal of sebaceous cysts.
3. Punch Biopsy Excision Technique
This technique uses laser punch or single-use disposable dermal punch to remove the cyst, excluding the outer walls, which will be excised a month later. It can be used in areas of high aesthetic importance to minimize scarring and for cosmetic reasons.
This technique is highly popular and the best treatment because of faster healing, less scarring, and minimal excision procedures. Many randomized trials have been carried out to test the procedures and assess patient satisfaction.
What is the Difference Between Minimal Excision and Punch Biopsy?
There is not much difference between the two, but punch biopsy or laser punch minimizes the scarring and bleeding by using a co2 laser to create a small hole. In some cases, the suturing of the site can be avoided, removing the cyst in a more aesthetically pleasing manner as it directly targets the site.
There were reduced complications with the use of co2 lasers and no wound dehiscence in clinical trials recurrence rate was reduced, and patient satisfaction was high. They ensure better hemostasis and reduce postoperative hematoma.
Why Should I Consider the Removal of the Cyst?
- Cysts, when arising on the face and scalp, becomes a matter of concern for cosmetic reason.
- Assebaceous cysts are slow-growing, they can increase over time. Later on, surgical removal becomes mandatory.
- To reduce inflammation and redness around the cyst and improve skin condition. It may hinder regular activity and day-to-day life and may be uncomfortable for the patient.
- It may cause swelling of the area, lead to keratin build-u,p and create an obstruction of the sebaceous duct.
- It can cause pressure and pain over the underlying structures.
- Tightness over the skin
- The procedure isn’t very complicated, but adequate care must be taken. Do not remove the band-aid and avoid wetting.
- Do not pull the stitches as the open wounds may delay the healing process and give rise to infection and inflammation.
- While showering, make sure to cover the area or take a sponge bath.
- In case of open incisions, regular dressings must be done.
- Apply the antibiotic ointments as prescribed by your surgeon.
- After the healing, there might be a long or short scar depending on the type of procedure, and the scar may fade away with time if not visit your nearest dermatologist.
How to deal with postoperative complications?
After surgery for sebaceous cysts, a patient might undergo certain complications. Contact your surgeon in case of:
- high fever
- tiny wounds or bruising
- pain and inflammation
- swelling after the removal of the cyst
- infection at the site of suture
- if incision opens, contact your surgeon
- excessive bleeding at the site
Follow-ups and check-ups are important to trace the improvements.
So, now I hope you are well informed on the sebaceous cyst and the available treatment options.