Management of Scrotal Sebaceous Cyst Removal
Complete surgical excision with minimal incision technique is the recommended treatment for scrotal sebaceous cysts, followed by proper wound care including keeping the area clean and dry, applying antibiotic ointment, and monitoring for signs of infection during the healing period. 1, 2
Preoperative Assessment and Preparation
- Diagnostic confirmation: Duplex Doppler ultrasound is recommended to confirm diagnosis and rule out other causes of scrotal pathology such as varicocele, hydrocele, testicular torsion, or tumors 1
- Skin preparation: Chlorhexidine-alcohol skin preparation should be used before the procedure to prevent surgical site infection 3
- Antimicrobial prophylaxis: A single dose of antimicrobial prophylaxis should be administered 1 hour before skin incision 3
Surgical Technique Options
Minimal incision technique (preferred approach):
- Small incision (2-3mm) made directly over the cyst
- Removal of cyst contents followed by complete excision of the cyst wall
- Associated with extremely low recurrence rates (0.66%) and excellent cosmetic results 2
Two-step procedure (for large or cosmetically sensitive cysts):
- First step: Small opening to drain cyst contents
- Second step: Complete excision of cyst wall approximately 1 month later
- Particularly useful for large cysts or those in areas of cosmetic concern 4
Complete excision (traditional approach):
- Removal of the entire cyst including the wall in one procedure
- Necessary when multiple cysts cover extensive areas of scrotal skin 5
Postoperative Care
- Wound care: Keep the surgical site clean and dry
- Pain management: Multimodal approach including:
- NSAIDs for pain and inflammation
- Scrotal support to minimize discomfort
- Cold compresses to reduce swelling 1
- Activity modification: Avoid strenuous physical activity for 1-2 weeks
- Follow-up: Evaluation at 1-2 weeks post-procedure to assess healing
Potential Complications and Management
- Infection: Monitor for increased pain, redness, swelling, or purulent discharge
- If infection develops, consider oral antibiotics effective against skin flora
- Recurrence: Complete excision of the cyst wall is essential to prevent recurrence 2
- Scarring: Minimal incision techniques help reduce visible scarring 2, 4
Special Considerations
- Multiple cysts: When multiple sebaceous cysts cover the entire scrotum, complete excision of all cysts may be necessary 5
- Alternative techniques: For patients concerned about scarring, laser techniques may be considered, though these are less commonly used 6
When to Refer to a Specialist
- Multiple or very large cysts
- Recurrent cysts after previous excision
- Signs of infection or inflammation
- Uncertainty about diagnosis
- Cysts with atypical features that raise concern for malignancy 3
Remember that proper histological examination of excised tissue is important to confirm diagnosis and rule out rare malignant transformation 3.