Treatment of Dermal Cysts
The recommended treatment for a dermal cyst is complete surgical excision, which is the gold standard for management and provides the lowest risk of recurrence. 1
Types of Dermal Cysts
Dermal cysts are common skin lesions that can present in various forms:
- Epidermoid cysts (previously called sebaceous cysts)
- Pilar cysts
- Dermoid cysts
Surgical Management Options
Standard Surgical Excision
- Complete surgical excision with removal of the entire cyst wall is the treatment of choice
- For well-defined, low-risk cysts less than 2 cm in diameter, a 4-mm margin around the cyst border is appropriate 2
- Larger cysts may require wider margins (6 mm or more) 2
Minimal Incision Techniques
- For cosmetically sensitive areas or smaller cysts
- Involves making a 2-3 mm incision, expressing cyst contents, and extracting the cyst wall 1
- Benefits include:
- Less invasive than complete surgical excision
- May not require suture closure
- Better cosmetic outcome
Suction-Assisted Excision
- Particularly useful for large epidermal cysts (>2 cm)
- Uses negative-pressure suction instead of lateral pressure
- Allows complete removal of cyst lining through a small incision
- Reduces risk of cyst rupture and fragmentation 3
Special Considerations Based on Location and Size
Large Cysts (>2 cm)
- May require preoperative imaging (CT) to determine exact location and extent 4
- Suction-assisted techniques may be beneficial 3
Anatomically Sensitive Locations
- Face/head: Consider minimal incision techniques for better cosmetic outcomes
- Floor of mouth: May require intraoral or extraoral approach depending on size and symptoms 5
- Near vital structures: May require specialized surgical planning
Ovarian Dermoid Cysts
- Different management approach from cutaneous dermal cysts
- Can be managed with either surgical excision or annual ultrasound surveillance
- Surgical excision recommended for cysts >10 cm or symptomatic cysts
- Annual ultrasound surveillance may be considered for asymptomatic cysts <10 cm 6
Management of Complications
Inflamed Cysts
- Difficult to excise when inflamed
- Preferable to postpone excision until inflammation has subsided 1
- May require antibiotics if infected
Ruptured Cysts
- Complete excision of cyst wall still necessary to prevent recurrence
- May require more extensive dissection
Post-Procedure Care
- Keep wound clean and dry
- Monitor for signs of infection
- Follow-up to ensure complete healing and no recurrence
Pitfalls to Avoid
- Incomplete removal of cyst wall (leading to recurrence)
- Excessive lateral pressure during removal (can cause rupture)
- Fragmentation of cyst lining (may cause infection and recurrence) 3
- Postponing treatment of inflamed cysts until inflammation subsides 1
While various techniques exist for removing dermal cysts, complete surgical excision remains the most definitive treatment with the lowest recurrence rate. The specific surgical approach should be selected based on cyst size, location, and patient factors.