From the Guidelines
A dermatologist or a general surgeon is the most appropriate specialist to remove a scalp epidermoid cyst. When considering the removal of a scalp epidermoid cyst, it is essential to prioritize specialists who can ensure complete removal of the cyst to prevent recurrence. Although the provided evidence 1 focuses on the management of skin and soft tissue infections, including inflamed epidermoid cysts, it does not specifically address the removal of non-inflamed epidermoid cysts. However, in the context of real-life clinical medicine, a dermatologist or a general surgeon would typically perform this procedure.
For a straightforward, uncomplicated scalp cyst, consulting a primary care physician who may perform the removal or refer to a specialist is a reasonable first step. The procedure involves numbing the area with local anesthesia, making a small incision, removing the entire cyst including its wall (to prevent recurrence), and closing the wound with a few stitches. This procedure usually takes 30 minutes or less in an outpatient setting.
In cases of larger cysts, those in cosmetically sensitive areas, or complicated cases, a dermatologic surgeon, general surgeon, or even a plastic surgeon might be recommended. Epidermoid cysts are benign, slow-growing collections of keratin under the skin that form when epidermal cells move deeper into the skin and multiply rather than sloughing off at the surface. Complete removal is crucial because partial removal often leads to recurrence of the cyst. Given the importance of complete removal for preventing recurrence, consulting a specialist such as a dermatologist or general surgeon is advisable.
From the Research
Type of Surgeon or Specialist
The type of surgeon or specialist who would remove a scalp epidermoid (epidermal inclusion) cyst includes:
- Dermatologists, as they are specialized in treating skin conditions and perform dermatosurgical procedures 2, 3
- Neurosurgeons, as they are involved in the excision of dermoid and epidermoid cysts, especially in cases where the cysts are located in the scalp and may be eroding through the cranium 4
- General surgeons or plastic surgeons, as they may also be involved in the surgical removal of epidermoid cysts, especially in cases where the cysts are large or complex 5
Surgical Procedures
The surgical procedures for removing a scalp epidermoid cyst may include:
- Elliptical excision, where the cyst is removed through an elliptical incision 2
- Minimal excision, where a small incision is made to remove the cyst 5
- Punch biopsy excision, where a small punch biopsy is used to remove the cyst 5
- CO2 laser incision, where a CO2 laser is used to make a small incision to remove the cyst 5
Treatment Options
The treatment options for epidermoid cysts include:
- Surgical excision, which is the first-line treatment for epidermoid cysts 2, 3
- Laser therapy, such as CO2 laser or erbium-YAG laser 2, 5
- Intralesional drainage injection of triamcinolone acetonide 2
- Photodynamic therapy (PDT), which has been shown to be effective in treating infected epidermoid cysts 5