A cyst is a closed sac of tissue that forms beneath the skin or in other body tissues, containing liquid, semi-solid, or gaseous material. Unlike a solid nodule, a cyst has a distinct wall or envelope that separates it from the surrounding healthy tissue. Yes, dermatologists are typically the primary medical specialists equipped to diagnose and manage the removal of common cysts on or just beneath the skin’s surface. A proper diagnosis is necessary before any procedure to determine the specific type of growth and rule out other potential skin conditions.
Common Types of Cysts Treated
Dermatologists frequently treat several types of skin cysts. The most common form is the Epidermoid Cyst, which develops when surface skin cells move inward instead of shedding naturally, creating a sac filled with keratin. This keratin is a thick, cheese-like material that can sometimes have a distinctive odor if the cyst ruptures. Epidermoid cysts are often mistakenly referred to as sebaceous cysts, even though they originate from the hair follicle, not the oil glands.
Another common type is the Pilar Cyst, which primarily forms from the root sheath of a hair follicle. These growths are most often located on the scalp and frequently appear in multiples, presenting as firm, smooth lumps beneath the skin. The material inside pilar cysts is also keratin, but it tends to be denser and smoother than the contents of an epidermoid cyst. Growths like Ganglion Cysts, which develop near joints and tendons, may require a referral to a hand surgeon or orthopedic specialist.
Methods for Removal
The method chosen for cyst removal depends on the cyst’s size, location, and whether it is currently inflamed or infected. Both primary methods are typically performed in the dermatologist’s office using a local anesthetic, such as lidocaine, to numb the area.
Surgical Excision
The preferred and most definitive treatment is Surgical Excision, which is the gold standard for minimizing recurrence. During this procedure, the dermatologist makes an elliptical incision around the cyst and carefully removes the entire sac wall intact, along with its contents. Removing the sac completely eliminates the source of the material, significantly reducing the likelihood of the cyst growing back. The wound is then closed with sutures, sometimes using internal sutures to minimize the visible scar.
Incision and Drainage (I&D)
Incision and Drainage (I&D) is often used when a cyst is acutely inflamed, painful, or infected. This technique involves making a small incision and draining the fluid or pus from the cyst cavity to relieve pressure and symptoms. However, I&D leaves the cyst wall intact, meaning the lining can continue to produce material, leading to a higher chance of the cyst reforming. In these cases, the goal is immediate symptom relief, and a full surgical excision may be deferred until the inflammation has resolved.
Post-Procedure Care and Expectations
After a cyst removal procedure, patients receive instructions to ensure proper healing and minimize complications. For an excisional procedure, the wound site will be dressed, and it is recommended to keep the area clean and dry for the first 24 to 48 hours. Depending on the incision size and location, sutures may need to be removed by the dermatologist one to two weeks after the surgery.
Patients should expect some mild swelling, bruising, or discomfort at the removal site, which can typically be managed with over-the-counter pain medication. Dermatologists aim to minimize scarring by orienting the incision along natural skin tension lines, often resulting in a small, smooth line that fades over time. The final appearance of the scar depends on the original size of the cyst and the patient’s individual healing characteristics.
If the cyst wall was not fully removed during the initial procedure, recurrence is possible. Even with careful surgical excision, a microscopic remnant of the wall lining can sometimes be left behind, causing the cyst to return. Following all post-operative wound care instructions is important to support the best possible outcome and reduce the risk of infection.