From the Guidelines
Complete surgical excision is the most effective management option for sebaceous cysts, as it involves removal of the entire cyst wall, preventing recurrence. Management options for sebaceous cysts include both conservative and surgical approaches. For asymptomatic cysts, observation is appropriate as many sebaceous cysts remain stable and cause no problems. Warm compresses can help reduce inflammation if the cyst becomes irritated. If infected, incision and drainage may be necessary, as suggested by the guidelines for cutaneous abscesses and inflamed epidermoid cysts 1.
According to the guidelines, effective treatment of inflamed epidermoid cysts, often mistakenly referred to as sebaceous cysts, entails incision, thorough evacuation of the pus, and probing the cavity to break up loculations 1. However, this approach has a high recurrence rate since the cyst wall remains.
Key considerations for managing sebaceous cysts include:
- Cyst size and location
- Presence of symptoms or infection
- Patient preference
- The goal of preventing recurrence, which is best achieved through complete surgical excision. Intralesional steroid injections can reduce inflammation but don't eliminate the cyst. These treatments are selected based on the individual patient's situation, with complete excision being the preferred method for permanent resolution, as sebaceous cysts develop from blocked sebaceous glands, and leaving behind any cyst wall tissue allows for recurrence.
From the Research
Management Options for Sebaceous Cysts
- Surgical excision is a common management option for sebaceous cysts, with a low recurrence rate of 0.66% reported in a study of 302 patients 2.
- Incision and drainage is another management plan for infected sebaceous cysts, which can be performed under local or general anesthesia 3.
- A minimal-incision technique has been described as a satisfactory alternative to conventional, more invasive surgery, with good cosmetic results 2.
- Single-prick local anesthesia for sebaceous cyst excision has been suggested as a method to reduce intraoperative pain and improve patient cooperation 4.
- Elliptical excision and closure by undermining the wound edges and mobilisation of the released skin can be used to remove epidermal cysts, with a low risk of relapses and recurrence 5.
- Laser therapy with CO2, erbium-YAG laser or intralesional drainage injection of triamcinolone acetonide are other treatment options for epidermal cysts 5.
- Routine pathologic evaluation of sebaceous cysts may not be necessary, but is recommended when clinical suspicion exists, as malignancy can occur in 0.3% of cases 6.
Considerations for Management
- The choice of management option depends on the size, location, and symptoms of the sebaceous cyst, as well as the patient's overall health and preferences.
- Surgical excision is generally considered the first-line treatment for epidermal cysts, but other options may be considered for smaller or less symptomatic cysts.
- The use of local anesthesia and minimal-incision techniques can help to reduce pain and improve cosmetic results.
- Patients should be informed of the potential risks and benefits of each management option, and should be involved in the decision-making process.