What are the implications of having two small likely sebaceous cysts on the scalp?

From the Guidelines

Having two small likely sebaceous cysts on the scalp typically has minimal implications and often requires no treatment unless they cause discomfort or cosmetic concerns. These benign growths form when sebaceous glands become blocked, causing keratin and sebum to accumulate under the skin. Most scalp sebaceous cysts remain small and asymptomatic, though they may occasionally grow larger over time. Some key points to consider about these cysts include:

• They are usually painless and do not cause any symptoms
• They can be found on the scalp, as in this case, or on other parts of the body
• If the cysts become bothersome, treatment options include simple observation, surgical excision, or minimal incision drainage, as noted in the management of similar skin conditions 1
• Surgical removal is the only way to prevent recurrence, as it removes the entire cyst wall
• It is essential to watch for signs of infection such as redness, pain, warmth, or discharge, which would require medical attention
• While these cysts are almost always benign, any rapid growth, ulceration, or unusual appearance warrants medical evaluation to rule out other conditions
• Avoid attempting to squeeze or puncture the cysts at home as this can lead to infection, scarring, or incomplete removal causing recurrence. In the case of the two small likely sebaceous cysts on the scalp, no immediate action is required, but monitoring for any changes in size, pain, or appearance is recommended, with consideration for follow-up with MRI if they enlarge or become painful.

From the Research

Implications of Having Two Small Likely Sebaceous Cysts on the Scalp

• The presence of two small hypoechoic lesions on the scalp, measuring 9 x 4 x 3 mm and 3 x 3 mm, respectively, is most compatible with sebaceous cysts 2.
• Sebaceous cysts are benign congenital anomalies that present as yellow cysts primarily on the upper body, and they can be treated with topical retinoids or surgical excision 2.
• The fact that there is no associated vascularity or hyperemia, and no aggressive features, suggests that these cysts are likely benign 2.
• If the cysts enlarge or become painful, follow-up with MRI is recommended for further evaluation 2.
• There are various techniques for removing sebaceous cysts, including conventional wide excision, minimal excision, and punch biopsy excision 3, 4.
• A new method for removing sebaceous cysts involves using a laser to make a small hole for removal of the content, followed by minimal excision of the cyst wall about 1 month later 3.
• The minimal excision technique for epidermoid (sebaceous) cyst removal is less invasive than complete surgical excision and does not require suture closure 4.
• It is essential to differentiate sebaceous cysts from other conditions, such as benign lymphoid aggregates, which can be challenging to distinguish from non-Hodgkin lymphoma 5.
• The distribution patterns of B and T lymphocytes within lymphoid aggregates can serve as a useful criterion to aid in the separation between benign and malignant aggregates 5.