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A skin cyst is a closed sac located under the skin that is usually filled with keratin, fluid or dead skin cells. The majority of are non-cancerous and develop slowly. Numerous people experience none and live with them for years. When it does cause trouble due to cosmetic concern, infection, growth or rupture, the only sure cure is surgical removal, and in the majority of cases, the cyst does not resolve spontaneously.
This page covers the kinds of skin cysts, when it's best to remove them and what to expect.
There are a number of varieties that will develop as a lump under the skin:
Most common are epidermoid cysts. They are formed when the cells migrate inward and multiply at the wrong level, creating a sac that is filled with keratin. They are most common on the face, neck, scalp and back. Sometimes incorrectly referred to as seborrheic cysts because they are not associated with the sebaceous gland.
Pilar (trichilemmal) cysts develop from a hair follicle and are most common on the scalp. They are hard to remove and are more often family occurrences than epidermoid cysts. Scalp multiple pilar cysts are quite common.
The sebaceous cysts are much less common and are actually a true glandular cyst. They do not have keratin, instead having sebum.
Dermoid cysts are present at birth; they are formed during fetal development when parts of the skin get trapped under the skin. They are most common around the eyes, nose, or scalp.
The type is important for planning excision because the anatomy and the risk of recurrence varies between the different types.
Surgical removal is not necessary for all cysts. Doctors may recommend watchful waiting for a small lump that doesn't cause symptoms and isn't growing. When surgery is the best option:
Here is a very important point: It is not sufficient to merely drain the cyst, the sac must be removed. The cyst wall is left behind and the cyst refills. Recurrence is avoided by complete excision – removing the intact sac and its contents.
Not every cyst needs surgery. Watchful waiting is reasonable for a small, stable, asymptomatic lump. Surgery becomes the right choice when:
The procedure is done under local anesthesia as a day case. You return to your home on the same day.
The surgeon cuts directly through the skin above the cyst, separates it from the surrounding tissue and excises the cyst in one piece. The integrity of the sac is important – once it bursts open during removal, the contents get into the wound and can lead to inflammation and recurrence. The wound is then stitched up.
A minimal-excision technique can be performed for small cysts in cosmetically sensitive areas. A puncture forms in a small area, the contents of the sac are squeezed out and the collapsed sac is drawn through the hole. This results in a smaller scar. The down side is that the recurrence rates are slightly higher, because you have to remove the sac wall through a smaller opening.
If a cyst is actively infected at the time of presentation, excision is usually deferred. Antibiotics are used to treat the infection, and if the inflammation is acute, then the cyst is removed electively. Opening an infected cyst increases the chances of a break in the wound and of not completely removing the cyst.
The tissue removed is usually sent to the pathologist for review. This will confirm the diagnosis and exclude rare atypical changes.
It takes a few days for most patients to resume normal activity. The first 48 hours the wound is left covered and dry. Sutures are taken out in 7-10 days, depending on the site. Scars are generally not noticeable, especially if the incision is positioned where skin folds can be found. The likelihood of hyperpigmentation on the healing scar is lowered by applying sun protection in the first 3 months.
Nehru Place clinic is established by Dr. Anup Dhir Senior Consultant Plastic and Cosmetic Surgery, Indraprastha Apollo Hospital, New Delhi for the excision of cysts that are present in the face, scalp, neck, trunk and limbs. Complete removal and the cosmetic result of the scar are taken into account in planning the incision.
Medically reviewed by Dr. Anup Dhir, MBBS, MS, MCh (Plastic and Reconstructive Surgery), FECSM.
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