Epidermal cysts, sometimes called by the outdated name, sebaceous cysts, are growths that develop from hair follicles just under the skin’s surface. They are benign and only need to be treated if they are large enough to be painful or irritated by clothing, get infected, or occur on a part of your body that makes them noticeable so that you would like to have them removed for cosmetic reasons.
Many people have cysts that have been present for many years and never have them treated without ever having anything bad happen. You can think of a cyst as being like a water balloon attached to the follicle. Instead of being filled with water it is filled with keratin which is made from dead skin cells. It is common for cysts to change in size so that they get a little bigger and/or smaller over time. As the lining makes more keratin the cyst fills up and expands or enlarges and as the lining absorbs some of the existing keratin, the cyst can get smaller. If a provider pokes a hole through the skin into the cyst, the cyst or “balloon” may deflate by draining some of the keratin, but the lining most likely will not be removed and the cyst will just fill back up again.
In order to keep the cyst from recurring, the whole cyst including all of the lining needs to be removed, not just drained. This is a routine procedure which can be done in our office under local anesthesia. If it is infected, the infection will need to be treated first before the cyst can be removed. Removal of a cyst involves several steps. First the skin surrounding the cyst will be cleaned with a sterilizing solution. Then the area will be anesthetized. We like to use tiny needles to inject the anesthesia and we also specially buffer our anesthetic to make it less painful, so there is minimal discomfort from the local anesthetic. A sterile drape is then place over the area to help prevent the wound from becoming infected. Next an incision is made over the cyst, just long enough to get the whole cyst out, including all of the lining.
If the cyst has ever been infected or you have squeezed it to try to drain it yourself, then it may be surrounded by scar tissue. If this is the case, then the incision may need to be longer in order to remove the cyst completely, thus leaving a little longer scar. Once the cyst is removed, the skin is closed in layers with inside stitches followed by outside stitches. The inside stitches not only help prevent internal bleeding, but they also take some of the stress and tension off the scar to help minimize the scar from widening over time and thus help keep the ultimate scar as small as possible. These stitches eventually dissolve and therefore are not removed. The outside stitches are then placed and the wound covered by a bandage. We will tell you how to take care of the area and you will also be given written instructions. You may also call the office if you have any questions. If it is after office hours you will be able to reach one of us by phone. We will always be available to you.
If your cyst has been infected or is painful then the procedure is usually covered by insurance. If you would like to have a cyst removed for cosmetic reasons then the removal will not be covered by insurance. The fees to remove a cyst are based on such factors as its size and location on the body. If you have a cyst you think you might like to have removed please make a consultation appointment with one of our providers who can answer all of your questions including insurance coverage and fees.