Sebaceous cysts, also known as epidermal cysts, are among the most common skin problems, usually presenting as a nodule under the skin, often with a punctum connecting to the surface. On the scalp similar cysts are termed pilar cysts. Sometimes there is an unpleasant odor and a cheese-like material may sometimes be expressed from a cyst. Sebaceous cysts can be uncomfortable due to their size, and unpleasant due to odor and leakage of materials. They can also sometimes get infected, or rupture leading to inflammation as cyst contents spill into the surrounding tissue.
A sebaceous cyst has a cyst wall, which serves to separate the cyst contents from the surrounding tissue. This wall must be removed in its entirety, along with all cyst contents, or the cyst has a high likelihood of returning. To surgically remove a sebaceous cyst, first the area is cleaned and prepped, then local anesthesia is injected around and under the cyst and in the skin overlying the cyst. After this a small incision or punch is made overlying the cyst, and the cyst wall is dissected away from the surrounding skin and subcutaneous tissue. Often a large cyst can be removed through only a small incision or punch. Evan a very large cyst can be taken out through a small incision by first expressing the cyst contents and then removing the cyst wall. Following removal of the cyst the area should be well irrigated with sterile saline, following which the incision can be repaired, usually by suturing the skin in layers.
Although a sebaceous cyst is a very common growth, it can sometimes be confused with other neoplasms. A nodule under the skin can also be a lipoma. Various developmental cysts will also present as cystic nodules. Various adnexal neoplasm can also present as nodules, as can cutaneous B-cell lymphoma, epithelioid sarcoma, Merkel cell carcinoma, and cutaneous metastases. However, when a central punctum is present and characteristic cyst-like contents expressed, the diagnosis is not much in doubt.
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