Who Removes a Chest Wall Cyst
A general surgeon or thoracic surgeon typically removes chest wall cysts, with the choice depending on cyst depth, size, and complexity. 1
Surgical Specialist Selection
Superficial Chest Wall Cysts (Epidermoid/Sebaceous Cysts)
- Primary care physicians or general surgeons can remove superficial epidermoid cysts using minimal excision technique under local anesthesia for lesions up to 5 cm. 2, 3
- Most physicians experienced in skin surgery can perform the minimal excision technique after 3-5 precepted sessions, making this accessible to trained family physicians. 2
- The procedure involves a 2-3 mm incision with expression of cyst contents and extraction of the cyst wall, typically requiring no suture closure for small lesions. 2
Deep Chest Wall Cysts
- Thoracic surgeons or board-certified general surgeons with advanced surgical skills should manage deep chest wall cysts that involve muscle layers or mediastinal structures. 1
- Deep thoracic wall cysts measuring >10 cm require minimally invasive surgical (MIS) approaches with careful dissection from trapezius muscle and cervical structures. 1
- These complex cases necessitate surgeons experienced in thoracoscopic techniques and chest wall anatomy. 1
Size-Based Surgical Considerations
Standard Cysts (<5 cm)
- Solitary epidermoid cysts up to 5 cm can be managed by general surgeons or trained primary care physicians under local anesthesia. 4, 3
- Complete excision of the cyst wall is mandatory to prevent recurrence, which occurs in 2.2% of cases when properly performed. 3
Giant Cysts (>5 cm)
- Giant epidermoid cysts (>5 cm) or multiple cysts require referral to general surgery for more extensive surgical planning. 4
- Large chest wall cysts (>10 cm) necessitate thoracic surgery consultation for potential MIS approach. 1
Critical Timing Considerations
Inflamed/Infected Cysts
- Postpone excision until inflammation subsides, as inflamed cysts are technically difficult to excise completely. 2
- However, infected sebaceous cysts can be excised with primary closure in the same sitting under local or general anesthesia, with excision of infected tissue plus a rim of healthy tissue. 5
- Sutures are removed on day 14 for limb locations and day 21 for back locations. 5
Common Pitfalls to Avoid
- Incomplete cyst wall removal leads to recurrence - the entire cyst wall must be extracted through the incision to prevent relapse. 2, 3
- Attempting excision during active inflammation increases technical difficulty and failure rates. 2
- Referring superficial cysts to thoracic surgery unnecessarily - most epidermoid cysts are straightforward procedures for general surgeons or trained primary care physicians. 2, 3
- Failing to obtain histopathology when clinical suspicion of malignancy exists, though routine histologic evaluation is unnecessary for typical presentations. 2