Recipient(s) will receive an email with a link to 'Epidermal Cysts: Minimal Excisional Removal' and will have access to the topic for 7 days.
Subject: Epidermal Cysts: Minimal Excisional Removal
(Optional message may have a maximum of 1000 characters.)
Basic office surgery instruments are used for the standard excision technique (Appendix G). However, the minimal sebaceous cyst removal technique can be performed with a no. 11 scalpel blade, two or three small mosquito hemostats, and sterile gauze.
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 sebaceous cysts, preferably those that have not previously been inflamed or scarred
Fluctuant or compressible lesions in common areas for sebaceous cysts (e.g., face, neck, scalp, behind the ears, trunk, scrotum)
Severe bleeding disorders
Failed previous minimum excision attempt on the specific lesion. A cyst that has previously ruptured and scarred to the surrounding tissue.
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.
PEARL: When working on the scalp, lightly taping the hair back often facilitates the procedure.
PEARL: Many operators fail to enter the cyst with the scalpel blade. By directing the blade toward the center of the cyst and inserting until a “give” is felt as the blade tip enters the cyst, the pass of the blade usually will be successful.
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: Once the cyst contents have been squeezed out, a mass may be palpated adjacent to the cyst, suggesting that a tumor may be present. It is recommended that the minimal excision technique be abandoned for a formal excision and biopsy. If malignancy is discovered in a cyst wall that is removed at the time of the minimal excision technique, the physician may consider a second excision.
PEARL: Any atypical-appearing lesion or one associated with a palpable irregularity in the cyst wall should be sent for histologic analysis.
PEARL: If adhesions are present, they may be reduced by semisharp dissection using Iris scissors.
PITFALL: If any cyst wall remains in the wound, the cyst will usually recur. It is critical that the entire cyst wall be removed. Sufficient preprocedure anesthesia should be administered to permit this vigorous tugging within the wound.
PITFALL: Occasionally, previous inflammation of the cyst causes scarring and tethering of the cyst wall to surrounding tissues. This usually prevents removal of the cyst wall by the minimal technique. If the operator is unable to remove the cyst wall using the minimal technique, the operator should convert to a standard removal, making a fusiform excision surrounding the skin opening.