From the Guidelines
A sebaceous cyst on the scrotum does not typically require treatment unless it becomes inflamed or infected, in which case incision, evacuation of the pus, and probing the cavity may be necessary, as suggested by the practice guidelines for the diagnosis and management of skin and soft-tissue infections 1. When considering treatment for a sebaceous cyst on the scrotum, it's essential to differentiate between a true sebaceous cyst and an epidermoid cyst, as the latter is more common and often mislabeled as a sebaceous cyst.
- Key factors to consider in deciding on treatment include:
- Size and growth rate of the cyst
- Presence of pain, inflammation, or infection
- Impact on quality of life and morbidity According to the guidelines 1, effective treatment of inflamed epidermoid cysts, which are often mistaken for sebaceous cysts, entails incision, thorough evacuation of the pus, and probing the cavity to break up loculations, rather than systemic antibiotics or other treatments.
- It's crucial to note that:
- Gram stain, culture, and systemic antibiotics are rarely necessary for the treatment of sebaceous or epidermoid cysts, unless there are unusual exceptions such as multiple lesions, cutaneous gangrene, or severely impaired host defenses 1.
- Simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound, although some clinicians may pack it with gauze or suture it closed 1.
From the Research
Sebaceous Cyst on Scrotum Treatment
- A sebaceous cyst is a benign encapsulated, subepidermal nodule filled with keratin material, and having several on the scrotum is an uncommon occurrence 2.
- If the cysts become infected or look unsightly, they should be removed, and histologically, cysts are lined by stratified squamous epithelium and contain keratin debris and cholesterol 2.
- Extensive large sebaceous cysts on the scrotum are rare and present a problem only when infected or when cosmesis is deemed unacceptable by the patient 3.
Removal of Sebaceous Cysts
- All the cysts had to be removed in toto because of an unusual presentation which was covering the entire scrotal skin 2.
- A new method with two steps is proposed for treating a sebaceous cyst: removal of the cyst content with a laser punch and the cyst wall with a minimal postponed excision 4.
- This method offers a good alternative for eradication of uninfected cysts, especially large cysts or cysts located in areas of thick skin or cosmetic concern 4.
Potential Complications
- Fournier's gangrene is an infective condition with a high death rate, and early surgical debridement is crucial to achieve satisfactory outcomes 3.
- Tuberculosis (TB) is a great mimic of many diseases and may present a dilemma in diagnosis, and nodular scrotal skin TB is extremely rare but should nonetheless be considered as a differential diagnosis in regions where it is prevalent 5.
- Surgical site infection (SSI) following minor surgery contributes to patient morbidity and compromises cosmetic outcomes, and the overall incidence of infection was 8.7% (95% confidence interval 6.5-11.0) 6.