Dermatologists routinely remove cysts, particularly those located on or near the skin’s surface. A cyst is a closed sac under the skin that contains fluid, semi-solid material, or air. These growths are typically benign (non-cancerous), but they can become bothersome due to their size, location, or if they become inflamed or infected. Dermatologists are highly trained in the precise diagnosis and removal of these common skin lesions in an outpatient setting.
What Kinds of Cysts Do Dermatologists Treat?
Dermatologists focus on the most common types of cysts that form from skin structures, mainly the hair follicle apparatus. The two most frequently treated are epidermoid cysts and pilar cysts, both filled with keratin protein.
Epidermoid cysts form when epidermal cells, which should naturally shed, become trapped beneath the skin and start to multiply. They typically appear on the face, neck, trunk, and upper back and often have a small, visible dark dot, or punctum, on the surface. Pilar cysts, also called trichilemmal cysts, almost exclusively develop on the scalp and are derived from the outer root sheath of the hair follicle. They are often firmer than epidermoid cysts and may occur in multiples, sometimes showing a hereditary pattern.
Most cysts do not require intervention unless they are symptomatic, but removal is often sought for cosmetic reasons or discomfort. A dermatologist may recommend removal if the cyst is causing pain, if it ruptures, or if it shows signs of inflammation or infection. The decision to remove is based on a professional assessment of the cyst’s type, size, and the patient’s concerns.
Detailed Surgical Removal Procedures
The goal of surgical cyst removal is to take out the entire sac (capsule) to prevent recurrence. The gold standard for a permanent solution is complete surgical excision, which involves using a local anesthetic to numb the area. The dermatologist makes an elliptical incision around the cyst to carefully dissect the entire sac away from the surrounding tissue.
After the sac is removed, the incision is closed with sutures, sometimes placed both internally and externally. This procedure typically takes between 15 and 45 minutes, depending on the cyst’s size and location.
Minimally invasive techniques reduce scarring but carry a slightly higher recurrence risk. Methods like punch biopsy excision use a small circular tool to remove a tiny core of skin over the cyst. This allows the contents and the collapsed sac to be extracted through a much smaller opening, which can be suitable for smaller lesions where cosmetic outcome is a major concern.
A different technique, called incision and drainage (I&D), is reserved for cysts that are acutely infected, inflamed, or abscessed. During I&D, the dermatologist makes a small cut to release the accumulated pus and fluid, which immediately relieves pressure and pain. This method is palliative rather than curative because the cyst wall is left behind, meaning the cyst may eventually refill.
Non-Surgical Management and Recovery
Observation is a suitable management approach for small, stable, and asymptomatic lesions. If a cyst becomes red and tender but is not fully infected, the dermatologist may utilize an intralesional steroid injection. This involves injecting a corticosteroid directly into the cyst to reduce inflammation and swelling, sometimes shrinking the lesion significantly.
Proper wound care following an excision is necessary to promote healing and minimize scarring. Patients are instructed to keep the surgical site clean and dry for the first 24 to 48 hours, then gently clean the area with mild soap and water. Strenuous physical activity that could stretch the incision should be avoided for about a week to prevent the sutures from breaking.
Non-dissolvable sutures are typically removed 7 to 14 days after the procedure. It is important for patients to monitor the site for signs of infection, such as increasing redness, warmth, or discharge. While surgical excision has a low recurrence rate, recurrence is possible if the cyst wall was not fully removed or if less invasive techniques were used.