How to remove a sebaceous cyst?

Sebaceous Cyst Removal Techniques

Complete surgical excision is the recommended treatment for non-inflamed sebaceous cysts, while incision and drainage is appropriate for inflamed or infected cysts. 1

Assessment Before Removal

• Determine if the cyst is:

  • Inflamed/infected (redness, swelling, pain, possible purulent drainage)
  • Non-inflamed (asymptomatic, mobile, firm)
  • Suspicious for malignancy (size >1.5 cm, rapid growth, ulceration)

• Location considerations:

  • Cosmetically sensitive areas may require specialized techniques
  • Anatomical constraints may limit excision margins

Removal Techniques

For Non-inflamed Sebaceous Cysts:

1. Complete Surgical Excision (Gold Standard)

   • Ensures complete removal of the cyst wall to prevent recurrence
   • Steps:
     • Clean the area with antiseptic solution
     • Administer local anesthesia
     • Make an incision along skin tension lines
     • Carefully dissect and remove the entire cyst with its wall intact
     • Close the wound with sutures
     • Remove sutures after 7-14 days (depending on location)

2. Minimal Excision Technique

   • Excellent for cosmetically sensitive areas
   • Steps:
     • Make a 2-3mm incision
     • Express cyst contents
     • Extract the cyst wall through the small opening using forceps
     • Close with 1-2 sutures
   • Shows low recurrence rates (0.66%) with good cosmetic results 2

3. Laser Punch-Assisted Technique

   • Two-step approach for cosmetically sensitive areas:
     • First: Create a small hole with laser to remove cyst contents
     • Second: Remove cyst wall through minimal excision about 1 month later
   • Results in minimal scarring and low recurrence 3

For Inflamed/Infected Sebaceous Cysts:

1. Incision and Drainage

   • Primary treatment for infected cysts 1
   • Steps:
     • Clean area with antiseptic
     • Administer local anesthesia
     • Make incision over the most fluctuant area
     • Completely evacuate pus and break loculations
     • Consider packing for large cavities
   • Plan for complete excision after inflammation resolves

2. Excision with Primary Closure

   • Alternative approach for infected cysts:
     • Excise infected tissue along with rim of healthy tissue
     • Close with sutures in the same sitting
     • Remove stitches after 14-21 days (depending on location) 4

Post-Procedure Care

• Keep the area clean and dry
• Monitor for signs of infection (increasing pain, redness, drainage)
• Apply antibiotic ointment if prescribed
• Take oral antibiotics only if specifically indicated (extensive cellulitis, systemic symptoms)
• Schedule follow-up for suture removal and wound assessment

Common Pitfalls to Avoid

1. Incomplete removal of cyst wall - Main cause of recurrence (2.2-8.3%)
2. Misdiagnosing inflammation as infection - Can lead to unnecessary antibiotic use
3. Failure to consider malignancy - Always send suspicious specimens for histopathology
4. Inappropriate antibiotic use - Reserve for true infections with systemic symptoms
5. Inadequate follow-up - Essential to monitor for proper healing and recurrence

For large or multiple cysts, particularly in cosmetically sensitive areas, referral to a dermatologist or surgeon with experience in cyst removal may be warranted 1, 5, 6.