Is surgical excision with histopathology examination medically indicated for a patient with multiple infected subcutaneous sebaceous cysts?

Surgical Excision with Histopathology for Infected Sebaceous Cysts is Medically Necessary, Not Cosmetic

Surgical excision with histopathology examination is medically necessary, not cosmetic, for multiple infected subcutaneous sebaceous cysts on the face that are painful, tender, and progressively increasing in size. 1

Clinical Indications for Surgical Intervention

• Infected sebaceous cysts with signs of inflammation (pain, tenderness) require surgical intervention as recommended by clinical practice guidelines 1
• Progressive increase in size over 3 months indicates active pathology requiring medical intervention rather than cosmetic treatment 1
• Ultrasound confirmation of infected cystic lesions provides objective evidence of medical necessity 1
• Multiple cysts (one on left cheek, two on right cheek) in a cosmetically and functionally sensitive area (face) warrant complete surgical excision 1

Surgical Management Approach

• Wide local excision is the treatment of choice for infected sebaceous cysts to prevent complications and recurrence 1
• Complete excision with removal of the entire cyst wall is necessary to prevent recurrence of infected cysts 1
• Marker sutures should be used during excision to properly orient the specimen for histopathological evaluation 1
• For facial lesions, careful surgical technique is essential to minimize scarring while ensuring complete removal 1

Necessity of Histopathological Examination

• Histopathological evaluation is medically necessary to:
  • Confirm the diagnosis and rule out malignant transformation 2, 3
  • Determine whether lateral and deep margins are clear of any pathology 1
  • Assess for any atypical features that might require additional treatment 1
• Infected cysts have a higher risk of complications and should always undergo histopathological examination 2, 3

Medical Complications of Untreated Infected Sebaceous Cysts

• Untreated infected sebaceous cysts can lead to:
  • Abscess formation and cellulitis requiring more extensive intervention 4, 3
  • Sinus tract formation and deeper tissue involvement 3
  • Scarring and tissue damage if rupture occurs 3, 5
  • Rare but possible malignant transformation in long-standing cases 2

Common Pitfalls to Avoid

• Attempting minimally invasive techniques (like incision and drainage alone) for infected cysts often leads to recurrence as the cyst wall remains 5
• Delaying surgical intervention for infected cysts can lead to more extensive infection and greater tissue damage 3
• Failure to perform histopathological examination may miss rare but serious pathology 2, 6
• Treating multiple infected facial cysts as merely cosmetic can lead to progression of infection and worse outcomes 1, 4

In this case, the combination of multiple factors—pain, tenderness, progressive growth, ultrasound-confirmed infection, and facial location—clearly establishes the medical necessity for both surgical excision and histopathological examination of these sebaceous cysts.