Treatment of Scrotal Inclusion Cysts
Small scrotal inclusion cysts should be surgically excised by a urologist when they become symptomatic, grow in size, or for cosmetic concerns.
Understanding Scrotal Inclusion Cysts
Scrotal inclusion cysts (also called epidermal inclusion cysts) are benign encapsulated, subepidermal nodules filled with keratin material. They are characterized by:
- Typically painless, slowly growing masses
- Lined by stratified squamous epithelium
- Contain keratin debris and cholesterol
- Can occur anywhere on the scrotum
Diagnosis
The diagnosis of scrotal inclusion cysts is primarily clinical and may include:
- Physical examination revealing a mobile, firm, non-tender nodule on the scrotal skin
- Ultrasound (if needed) showing a well-circumscribed, hypoechoic lesion without internal vascularity
- Definitive diagnosis is made histologically after excision
Management Algorithm
Asymptomatic small cysts:
- Observation is reasonable if the cyst is small and not bothering the patient
- Regular monitoring for changes in size or symptoms
Indications for surgical removal:
- Symptomatic cysts (pain, discomfort)
- Cosmetic concerns
- Growth in size
- Infection or inflammation
- Diagnostic uncertainty
Surgical approach:
- Complete excision of the cyst with its capsule (enucleation)
- Performed under local anesthesia in most cases
- Care taken to avoid damage to surrounding structures
Who Performs the Procedure
A urologist typically performs the surgical removal of scrotal inclusion cysts 1. This is appropriate because:
- Urologists specialize in disorders of the male genitourinary system
- They have expertise in scrotal anatomy and surgical techniques
- They can manage any potential complications
Surgical Technique
The surgical procedure involves:
- Local anesthesia administration
- Small incision over the cyst
- Careful dissection to separate the cyst from surrounding tissues
- Complete removal of the cyst with its capsule
- Closure of the wound with absorbable sutures
Important Considerations
Differential diagnosis: It's important to distinguish scrotal inclusion cysts from other scrotal masses including testicular tumors, hydroceles, varicoceles, and spermatoceles 2
Recurrence: Complete excision with the cyst wall minimizes the risk of recurrence
Multiple cysts: In rare cases where multiple cysts cover a large area of the scrotum, more extensive surgery may be required 1
Infection risk: Infected cysts require more urgent intervention and may need antibiotic therapy before or after excision
Follow-up
- Single follow-up visit to ensure proper healing
- No long-term follow-up is typically needed after complete excision
- Patient education about monitoring for recurrence or development of new cysts
Scrotal inclusion cysts are benign lesions with excellent prognosis following complete surgical excision. While observation is reasonable for asymptomatic small cysts, surgical removal by a urologist is the definitive treatment when indicated by symptoms, growth, or cosmetic concerns.