What is the proper procedure for lancing a cyst?

How to Lance a Cyst

The proper procedure for lancing a cyst involves making a small 2-3 mm incision, expressing the contents through compression, and extracting the cyst wall through the incision to prevent recurrence. 1

Preparation and Assessment

• Determine if the cyst is appropriate for lancing - epidermal cysts are dome-shaped, asymptomatic lesions that often arise from ruptured pilosebaceous follicles 1
• Use protective equipment including gauze or a splatter shield to protect yourself from spraying of cyst contents during the procedure 1
• Consider postponing the procedure if the cyst is inflamed, as inflamed cysts are more difficult to excise 1

Procedure Steps

1. Anesthesia

   • Apply local anesthesia to the area surrounding the cyst 2

2. Incision

   • Make a small 2-3 mm incision on the cyst surface 1
   • For larger cysts (>2 cm), the incision length may need to be 0.7-1.8 cm (average 1.0 cm) 3

3. Content Removal

   • Express the cyst contents through compression 1
   • For larger cysts, consider using negative-pressure suction instead of lateral pressure to avoid unintended rupture or fragmentation of the cyst lining 3

4. Cyst Wall Extraction

   • Extract the entire cyst wall through the incision 1
   • Complete removal of the cyst lining is crucial to prevent recurrence 3

5. Closure Options

   • For uninfected cysts: The minimal excision technique doesn't require suture closure 1
   • For infected cysts: Consider excising the infected tissue along with a rim of healthy tissue and closing with sutures 2

Post-Procedure Care

• If sutures were placed, remove them after appropriate healing time (14 days for limbs, 21 days for back) 2
• Monitor for complications such as hematoma formation 3

Potential Complications and Pitfalls

• Incomplete removal of the cyst wall is the most common cause of recurrence 1
• Lateral pressure can cause unintended rupture or intracavitary rupture 3
• Fragmentation of the cyst lining into small pieces may cause infection and recurrence 3
• Using incisions that are too small can cause tension, leading to heat buildup, sloughing, dehiscence, and potential implantation of epidermal cells under the dermis 4

Special Considerations

• For large cysts (>2 cm in diameter), traditional manual squeezing techniques may be insufficient, and negative-pressure suction methods may be more effective 3
• Thorough irrigation should be performed to flush away debris and avoid potential foreign body reactions 4
• Histologic evaluation is only necessary if unusual findings or clinical suspicion of cancer is present 1