Sebaceous Cyst Treatment
Complete surgical excision with removal of the entire cyst wall is the recommended treatment for non-inflamed sebaceous cysts to prevent recurrence. 1
Treatment Approach Based on Cyst Status
Non-inflamed Sebaceous Cysts
- Primary treatment: Complete surgical excision with removal of the entire cyst wall
- Standard excision with 4-6 mm margins to mid-subcutaneous adipose tissue is appropriate for low-risk areas 2
- Ensures removal of the complete cyst wall to prevent recurrence (2.2-8.3% recurrence when removal is incomplete) 1
- Mohs micrographic surgery may be considered for high-risk anatomical locations 2
Inflamed/Infected Sebaceous Cysts
- Traditional approach: Incision and drainage, followed by excision after inflammation subsides 1, 3
- Alternative approach: One-stage excision with antibiotic coverage
- Research shows this decreases antibiotic exposure duration, reduces morbidity, and is more economical 3
- Appropriate patient selection is important for this approach
Minimally Invasive Options
For patients concerned about scarring, especially in cosmetically sensitive areas:
CO2 Laser Punch-Assisted Surgery:
- Creates a small hole to remove cyst contents
- Allows removal of cyst wall through minimal incision
- Results in minimal scarring with 6% overall recurrence rate (0% for uninfected cysts) 4
- Mean operation time: 13 minutes
Two-Step Laser Procedure:
- Step 1: Laser creates small hole to remove contents
- Step 2: Cyst wall removal via minimal excision approximately 1 month later
- Particularly useful for large cysts or those in areas of cosmetic concern 5
Post-Operative Care
- Proper wound care with dressing changes
- Monitor for signs of infection
- Follow-up within 7-14 days to assess healing and remove sutures 1
- Consider systemic antibiotics only in specific situations:
- Temperature >38.5°C or heart rate >110 beats/minute
- Erythema extending >5 cm beyond wound margins
- Presence of systemic inflammatory response syndrome
- Markedly impaired host defenses
- Extensive surrounding cellulitis 1
Special Considerations
Histopathological examination is recommended if the cyst has suspicious features:
- Size greater than 1.5 cm
- Rapid growth
- Nodular mass
- Ulceration
- Extensive scarring
- Fixation to surrounding tissues 1
Multiple or extensive cysts (such as those covering large areas) may require more extensive surgical planning 6
Treatment Algorithm
- Assess cyst status: Inflamed vs. non-inflamed
- Consider location: Cosmetically sensitive vs. non-sensitive area
- Evaluate patient preference: Conventional vs. minimally invasive approach
- Select appropriate technique:
- Standard excision for most non-inflamed cysts
- Incision and drainage followed by delayed excision OR one-stage excision with antibiotics for inflamed cysts
- Minimally invasive techniques for cosmetically sensitive areas
Complete surgical excision remains the gold standard treatment with the lowest recurrence rates, but treatment selection should consider the specific characteristics of the cyst and patient factors.