What is the treatment for a sebaceous cyst?

Treatment of Sebaceous Cysts

The most effective treatment for sebaceous cysts is complete surgical excision with removal of the entire cyst wall to prevent recurrence. 1, 2

Types of Sebaceous Cysts

Sebaceous cysts (more accurately termed epidermoid cysts) are benign, encapsulated subepidermal nodules filled with keratin material. They are commonly found on areas with hair follicles such as the scalp, face, neck, back, and occasionally the scrotum 3.

Treatment Algorithm

1. Non-inflamed Sebaceous Cysts

• Complete surgical excision is the treatment of choice 2
  • Excise with a minimum 4-mm margin around the cyst border 1
  • Ensure complete removal of the cyst wall to prevent recurrence
  • Submit excised tissue for pathological examination, especially if:
    • Size >1.5 cm
    • Suspicious features (rapid growth, fixation to surrounding tissues)
    • Unusual clinical presentation 2

2. Inflamed/Infected Sebaceous Cysts

Two approaches are possible:

Option A: Incision and drainage followed by delayed excision (conventional approach)

• Incise and drain the infected cyst
• Administer antibiotics
• Perform complete excision 1-2 months later when inflammation subsides 4

Option B: One-stage excision (newer approach)

• Excise the infected cyst along with a rim of healthy tissue in one procedure
• Follow with short course of antibiotics (typically 5 days)
• This approach has shown decreased antibiotic exposure, reduced morbidity, and is more economical 4, 5

Surgical Techniques

Standard Excision

1. Administer local anesthesia
2. Make an elliptical incision over the cyst
3. Carefully dissect around the cyst wall
4. Remove the entire cyst intact
5. Close the wound with sutures
6. Remove sutures in 7-14 days (depending on location) 2

Minimal Incision Technique

• For cosmetically sensitive areas
• Involves smaller incision with careful dissection
• Shows low recurrence rates (0.66%) with good cosmetic results 6

Special Anatomical Considerations

• For cysts on the face or lip: Consider intraoral approach to avoid visible scarring 7
• For scrotal cysts: Complete excision is recommended, especially if multiple or symptomatic 3

Post-Procedure Care

• Keep the wound clean and dry
• Monitor for signs of infection (increasing pain, redness, swelling, purulent drainage)
• Schedule follow-up to assess wound healing and remove sutures 2

Complications and Outcomes

• Recurrence rates range from 2.2-8.3% depending on technique used 2
• Main cause of recurrence is incomplete removal of the cyst wall
• Infection is the most common complication

Important Considerations

• Sebaceous cysts are not true sebaceous cysts but epidermoid cysts containing keratinous material 1
• Inflammation occurs as a reaction to rupture of the cyst wall and extrusion of its contents into the dermis, rather than as an infectious complication 1
• Suspicious features warranting pathological examination include nodular mass, ulceration, extensive scarring, lash loss, or localized crusting 1

By following this treatment approach, most sebaceous cysts can be effectively managed with minimal recurrence and good cosmetic outcomes.