From the Research
The recommended management for a scalp cyst typically involves surgical excision for complete removal, as this approach minimizes the risk of recurrence and allows for pathological examination to rule out malignancy. For symptomatic or enlarging cysts, the procedure is performed under local anesthesia, where the entire cyst wall is carefully removed to prevent recurrence 1. Prior to surgery, the area is cleaned and the hair around the cyst may be trimmed. Antibiotics are generally not needed unless the cyst is infected, in which case oral antibiotics like cephalexin 500mg four times daily for 7-10 days may be prescribed before surgical intervention. For infected cysts, incision and drainage might be performed first, followed by complete excision after the infection resolves. Small, asymptomatic cysts can be monitored without treatment if they're not bothering the patient.
Following excision, patients should keep the area clean and dry for 24-48 hours, and may need to return for suture removal in 7-14 days depending on the closure technique. Surgical removal is preferred over aspiration because aspiration typically leads to recurrence since the cyst wall remains intact. Most scalp cysts are benign sebaceous or epidermoid cysts, but the excised tissue should be sent for pathological examination to rule out malignancy. The use of intralesional injections of corticosteroids or doxycycline may be considered in some cases, as seen in the treatment of pseudocysts of the scalp 2. However, the most recent and highest quality study supports surgical excision as the primary treatment approach 1.
Some key points to consider in the management of scalp cysts include:
- Surgical excision is the preferred treatment approach to minimize recurrence and allow for pathological examination.
- Antibiotics may be prescribed if the cyst is infected, but are not generally needed for uncomplicated cases.
- Small, asymptomatic cysts can be monitored without treatment if they're not bothering the patient.
- The excised tissue should be sent for pathological examination to rule out malignancy.
- Intralesional injections of corticosteroids or doxycycline may be considered in some cases, but surgical excision is the primary treatment approach.