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Subject: Epidermal Cyst Excision
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The basic office surgery instruments are used for the standard excision technique (see Appendix G).
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Skin preparation recommendations appear in Appendix E.
Lesions with the clinical findings or appearance of epidermal cysts
Severe bleeding disorders
Failed previous minimum excision attempt on the specific lesion
PEARL: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
PITFALL: If the needle tip is placed inadvertently within the cyst, the anesthetic will increase pressure and cause the cyst to explode, often shooting the sebaceous material across the room.
PITFALL: Cutting too deeply increases the chances of inadvertent puncture of the cyst, with spillage of the cyst contents and resultant inflammatory response.
PEARL: If the cyst is accidentally entered, use a small hemostat to clamp the hole. It is much easier to excise a full cyst than a deflated one.
PITFALL: The clinician should not be positioned directly over the cyst. Opening a cyst that is under pressure can result in upward spraying of the cyst’s contents. Hold some gauze in the nondominant hand to act as a shield when opening the cyst.
PITFALL: When attempting to dissect the base of the cyst, be care to not remove excessive normal tissue below the cyst, because this creates a large deep defect that must be closed.