Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2002;65(7):1423-1424

What is an epidermoid cyst?

An epidermoid cyst is a benign (not cancer), slow-growing skin growth that results from injury to a hair follicle in association with acne, from a defect in the skin or from injury to the skin beneath the skin surface. The cyst contain a cheesy yellow material. Rupture of the cyst can release some of the cheesy material into the skin, resulting in a reaction that produces redness, tenderness and swelling.

Where are epidermoid cysts commonly found on the body?

Epidermoid cysts commonly appear on acne-prone areas of the face, neck and upper trunk. Cysts may also be found on the scrotum, behind the ears or on the scalp. Epidermoid cysts are rarely found on the fingers, palms of the hands or soles of the feet. Miniature epidermoid cysts (called milia) can develop in skin that is injured or scraped.

Are there any problems or complications associated with epidermoid cysts?

Ruptured cysts can cause skin scarring and discomfort. Rarely, cysts can develop an associated skin cancer. Epidermoid cysts are often a cosmetic problem or a cause of embarrassment for people. One of the major problems comes from growths that appear to be benign epidermoid cysts but are actually more aggressive skin tumors.

What is the minimal excision technique?

This simple, effective surgical procedure removes the cyst wall and the cheesy material inside the cyst. If the entire cyst wall is removed, the chance of the cyst coming back is low. A tiny cut is made in the skin following the administration of local anesthesia (numbing medicine). The cyst contents are squeezed out and the cyst wall is pulled through the tiny skin opening. The skin opening is so small that sutures (stitches) are often not needed to close the wound.

Is the minimal excision technique always successful in removing the cyst wall?

The doctor may not be able to pull the cyst wall through the small skin incision. Cysts that have been inflamed or previously ruptured may have extensive scarring around the cyst wall and be more difficult to remove. If the cyst wall can't be removed, your doctor will perform a standard removal technique through a larger incision.

Following Minimal Excision of Epidermoid Cyst

  1. Your doctor will ask you to use your hand to hold direct, firm pressure on the site after the procedure. Because no deep stitches are placed in the wound, it is important that pressure be applied so blood will not collect where the cyst was.

  2. Antibiotic ointment will be applied to the wound immediately after the procedure. Antibiotic ointment should be applied daily until the wound is completely healed.

  3. Some gauze may be taped over the surgery site, unless the cyst was on your scalp. If the gauze becomes soaked with blood, apply firm pressure over the area and change the gauze. If the bleeding continues despite the pressure, call your doctor. The gauze can be removed the morning after your procedure, and the site can be covered with an adhesive bandage.

  4. Some wounds will have a clear or yellow fluid drainage after this procedure. The drainage is fairly common after the removal of large cysts. This drainage usually stops within 1 week after the surgery. If pus drainage is noted, especially if the wound is red or tender, call your doctor.

  5. You can take a shower 36 hours after the procedure. You can take a bath once the wound has completely healed. Do not take a bath or swim while the wound remains open, or if fluid drainage is noted. Vigorous physical activity can be resumed 1 week after your procedure.

  6. Occasionally, a small piece of cyst wall may remain beneath the skin, and the cyst can reform. If you notice a lump or cyst at or near the original surgery site, return to be examined by your doctor.

  7. If stitches are used to close your wound, you will be asked to return to the office to have them removed in 7 to 10 days.

  8. Report any problems, such as infection or bleeding, to your doctor.

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