Minimal Sebaceous Cyst Excision: Procedure & Recovery

Overview

A sebaceous cyst is a slow-growing, fluid-filled, dome-shaped, yellow or white lump originating from the sebaceous glands. Sebaceous glands are tiny glands located all over your body that produce a mixture of oils called sebum that coats your skin and hair. Sebaceous cysts can be treated by draining or surgically removing them. Minimal sebaceous cyst excision is one of the most widely used surgical methods performed through small incisions in the skin overlying the cyst. The procedure's benefits include minimal scarring due to small incisions (cuts), reduced bleeding, and post-op complications.

How are Sebaceous Cysts Treated?

Sebaceous cysts are small, round lumps over the skin that are formed due to damaged or blocked sebaceous glands. The treatment for sebaceous cysts usually depends on their size and location. Smaller sebaceous cysts that are not bothersome can be left alone without any treatment. 

However, aesthetically unpleasant and large cysts need to be treated through the following methods:

Steroid injections

• In this procedure, steroids are injected into the cyst directly using small needles. 
• The drugs injected will reduce the inflammation and eventually shrink the cyst. 

Incision and drainage

• This procedure involves numbing the area around the cyst and making a small cut or prick on the skin over the cyst.
• The contents of the cyst are squeezed with digital pressure and removed. 

Surgical removal

Conventional wide excision

• A single large incision (cut) is made over the cyst that completely removes the cyst along with its content and walls.

Minimal excision

• A small stab incision is made in the center of the cyst using a surgical instrument.
• Slight compression is used to allow the cyst's contents to pass through the incision, and later the entire cyst sac is extracted.

Punch excision

• This procedure involves making a small incision to get access to the cyst.
• A special scalpel known as a cookie cutter removes the cyst along with a small margin of normal skin around it.

Laser-assisted excision

• This method uses a laser to create a small hole over the cyst to remove the contents. 
• The outer walls of the cyst are removed a month later.

What is Meant by Minimal Sebaceous Cyst Excision?

A minimal sebaceous cyst excision is a less invasive and successful procedure used to remove sebaceous cysts. It involves incisions measuring around 2 to 3 mm on the skin over the cyst using surgical instruments such as a scalpel (a surgical knife). Finger or digital pressure is applied over the cyst to express the cyst contents through a smaller opening than the actual size of the cyst. This will loosen the cyst wall from the surrounding tissues to facilitate the removal of the sac. The wound is usually not closed through stitches; instead, it is often left open and covered with a surgical dressing that must be changed every 2 days until the wound is healed completely.

When is Minimal Sebaceous Cyst Excision Recommended?

Minimal excision surgery for a sebaceous cyst is usually recommended to treat sebaceous cysts that are not cured through other methods like steroid injections or drainage. The indications for the minimally invasive surgery for a sebaceous cyst include:

• Infection and inflammation of the sebaceous cyst cause symptoms like severe pain, swelling, soreness, skin discoloration, and infection-related symptoms (fever, chills, body aches).
• When the sebaceous cyst is large and located in the areas where a conventional cyst excision would leave behind an ugly-looking scar.
• Signs of malignancy (cancer-causing ability) when the cyst grows rapidly.

How to Prepare for Minimal Sebaceous Cyst Excision?

You must consult your doctor and discuss your symptoms (pain, swelling, fever, discomfort, etc.) associated with a sebaceous cyst, which will help your doctor further evaluate your condition.

Medical history 

Your doctor will record your medical history to:

• Rule out other medical conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), asthma, blood disorders, and other related diseases of the heart, lungs, kidneys, etc. 
• Evaluate your history of previous surgeries, injuries and allergy to anesthesia, latex and other medications.
• Determine the medications taken, such as blood thinners, anti-inflammatory and anti-hypertensive drugs, antidepressants, and other herbal supplements.

Physical examination

Your doctor will examine the cyst and the clinical features that are represented by the cyst, such as the shape, size, color, and mobility (if the cyst is freely movable)

Diagnostic tests

Your doctor will order a few diagnostic tests to evaluate your general health and to determine the size and location of the sebaceous cyst. These include:

• A skin culture- A part of your skin around the cyst is collected and sent to the laboratory to check for any infection.
• Complete blood count- Your blood sample will be taken to check the levels of your blood components like red blood cells, white blood cells, etc. It also identifies the presence of any blood disorders.
• An ultrasound scan- This test uses ultrasound waves to determine the content of the cyst.
• A CT (Computed Tomography) scan- This helps check the exact location and size of the cyst that needs removal. A CT scan may also rule out other abnormalities.

Preparation

• Your doctor will discuss the benefits and risks involved with the procedure.
• You will be advised to discontinue certain medications, like blood thinners, antidepressants, etc., that may alter the course of the surgery and lead to any post-op complications.
• You must avoid smoking and alcohol consumption 2 weeks before the procedure.
• Before the minimal sebaceous cyst excision, you must fast for 8 to 12 hours.
• You must sign a consent form before the procedure to give your surgeon permission to perform the procedure. 
• You must arrange for someone to help you drive home after the procedure.

How is Minimal Sebaceous Cyst Excision Performed?

Minimal sebaceous cyst excision is a minimally invasive procedure (does not involve extensive cuts or bleeding) performed by a dermatologist (a doctor specializing in the disorders of skin, hair, and nails) or a general surgeon (a doctor who specializes in the surgical treatment of body tissues to treat medical conditions), usually under local anesthesia (a numbing agent that is used to numb only the area where it is injected).

• On the day of the surgery, you will be prepped for the excision by shaving the area to be treated (to remove excess hair), and the surgical site will be disinfected with an antiseptic solution.
• Your surgeon will inject local anesthesia near the sebaceous cyst so the surgery can be done without much pain and discomfort. However, general anesthesia (a numbing agent that puts you to sleep) can be used if the sebaceous cyst is severely infected or inflamed.
• Once the area is numbed, your surgeon will make an elliptical-shaped incision over the skin overlying the cyst using a scalpel (a special surgical knife).
• The incision will measure around 2 to 3 mm in diameter (minimal cut), which cuts through the connective tissue to expose the cyst.
• Your surgeon will then use scissors for a blunt dissection inside the cyst. This means carefully separating the cyst sac and lining from the surrounding tissues.
• Your surgeon will carefully separate the cyst from its base and use finger pressure to compress the cyst to extract it.
• The surgeon will use a gauze or a splatter shield to protect against the spraying of cyst contents during the excision.
• Your surgeon will carefully examine the cavity to check for any residual cyst content, disinfect it using saline solution, and pack it with a medicated gauze.
• The cyst tissues will be sent for a biopsy to rule out the possibility of malignancy.
• Usually, the incision will not be stitched; instead, a surgical gauze or dressing will be secured to heal.
• The procedure usually takes around 20 to 30 minutes, depending on the size, location, and the sebaceous cyst's infection.

What to Expect after Minimal Sebaceous Cyst Excision?

Once the excision is completed, you will be shifted to the recovery room while your vitals (blood pressure, pulse, heart rate, sugar levels, etc.) will be monitored.

• You will likely experience mild pain and discomfort once the effect of anesthesia wears off. Your surgeon will prescribe painkillers to help ease the pain.
• You will be sent home the same day once you are stabilized and can walk without support and discomfort.
• Your surgeon will also prescribe antibiotics to prevent the risk of post-op infection.
• Once you are back home, rest the day and avoid scratching or rubbing your surgical site.
• Keep your surgical site clean and dry by changing the dressing every 2 days until it heals. This is usually done by a nurse at your doctor’s clinic.
• Do not soak your surgical wound; avoid swimming, saunas, and tub baths for at least 2 to 3 weeks.
• Avoid direct exposure to sun or dust for the initial few days following the excision.
• It is normal to experience some discharge from the surgical wound, which will resolve as it heals.
• After 7 to 10 days, the scab tissue will form and fall off, and new skin will start forming after 10 to 14 days.
• Complete healing and recovery may usually take around 2 weeks, depending on the size and location of the cyst.

What are the Benefits and Risks of Minimal Sebaceous Cyst Excision?

Minimal sebaceous cyst excision is a safe and widely used surgical technique to remove infected or inflamed sebaceous cysts. This is an effective surgical approach with the following benefits:

Benefits

• The cut or incision is usually narrower than the actual size of the cyst with minimal bleeding.
• Minimal scarring since the procedure involves small cuts with less bleeding and trauma.
• It usually minimizes unfavorable post-op risks associated with the conventional method, such as pain, swelling, bleeding, and wound infection.
• Shorter operating time.
• Shorter recovery time with quick healing. 

Risks

A few risks involve minimal excision technique of sebaceous cysts, like any other surgical procedure:

• Allergic reactions to anesthesia cause skin rashes, hives, itching, discoloration, nausea, vomiting, dizziness, confusion, and breathing difficulties.
• Wound infection with/without ous discharge. This can be accompanied by other symptoms like high-grade fever (>103?), body aches, chills, and fatigue (extreme tiredness).
• Visibly unpleasant scarring if not performed by an experienced surgeon (improper technique).
• High risk of cyst recurrence, possibly due to compromised visibility due to smaller incisions.

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