Management of Scrotal Cyst
Surgical excision is the recommended management for a long-standing scrotal cyst, especially one that has been draining foul-smelling fluid, as this indicates potential infection and warrants complete removal to prevent recurrence. 1, 2
Clinical Assessment of Scrotal Cysts
- Scrotal cysts are typically benign, subepidermal nodules filled with keratin material
- Key characteristics to note:
- Size (the patient's cyst is 1 cm in diameter)
- Location (superficial in this case)
- Duration (present for years)
- Symptoms (drainage of thick foul-smelling fluid indicates infection)
- Appearance (smooth, mobile, non-tender unless infected)
Diagnosis
- The clinical presentation is consistent with a sebaceous cyst (also called epidermal cyst)
- Sebaceous cysts are common in hair-bearing areas including the scrotum 1
- The history of foul-smelling drainage suggests previous infection or inflammation
Management Options
1. Surgical Excision (Recommended)
- Complete surgical excision is the definitive treatment for symptomatic scrotal cysts 1, 2
- Benefits:
- Prevents recurrence by removing the entire cyst wall
- Allows for histopathological examination
- Resolves symptoms permanently
- Addresses cosmetic concerns
- Technique:
- Local anesthesia is typically sufficient
- Complete removal of the cyst with its capsule intact
- Careful dissection to avoid damage to surrounding structures
2. Alternative Approaches (Not Recommended for This Case)
- Incision and drainage:
- Not recommended as it leads to high recurrence rates
- Only temporarily relieves symptoms
- Observation:
- Not appropriate given the history of drainage and infection
- Percutaneous sclerotherapy:
- While effective for some fluid-filled cysts 3, not recommended for infected sebaceous cysts
Post-Procedure Considerations
- Wound care instructions
- Monitor for signs of infection
- Follow-up to assess healing and rule out recurrence
Special Considerations
- Multiple cysts may require more extensive surgical planning 1, 2
- For very large cysts, reconstruction techniques may be needed
- Histopathological examination should be performed to confirm diagnosis and rule out malignancy
Conclusion
The scheduled surgical removal on 08/22/25 is appropriate management for this patient's scrotal cyst. The history of long-standing presence and foul-smelling drainage indicates that complete surgical excision is necessary to provide definitive treatment and prevent recurrence.