Sebaceous Cyst Surgery

A sebaceous cyst (also called an epidermoid cyst or epidermal inclusion cyst) is a common, benign, slow-growing lump that develops under the skin.

Origin: Arises from blocked sebaceous glands or hair follicles. It contains keratin and lipid-rich debris, not true sebum.

Common Sites: Scalp, face, neck, back, trunk, scrotum.

Appearance:

• Smooth, round, firm, mobile lump under the skin.
• Size varies (few mm to several cm).
• Sometimes has a visible punctum (tiny black opening).

Symptoms:

• Usually painless.
• May become painful, red, and swollen if infected.
• Can discharge foul-smelling, cheesy material if ruptured.

Diagnosis:

• Clinical examination is usually sufficient.
• Ultrasound can confirm cystic nature if needed.
• Histopathology after excision to rule out rare malignancy (sebaceous carcinoma, SCC).

Management:

1. Asymptomatic, small cysts → Observation only.

2. Symptomatic / cosmetic concern / recurrent infection →

• Complete surgical excision with wall intact (to prevent recurrence).
• Incision & drainage only if infected, followed by delayed excision after inflammation subsides.

3. Antibiotics if secondarily infected.

Complications:

• Infection → abscess formation.
• Rupture → inflammation, scarring.
• Rare malignant transformation (extremely uncommon)