Sebaceous cysts are small lumps filled with cheese-like or oily material. They often arise due to swollen hair follicles. A sac of cells is formed in which, a protein named keratin is secreted. People having cysts also have one of their family members who also have them.
There are basically three main techniques are used for sebaceous cyst treatment: punch biopsy excision, conventional wide excision and minimal excision. But, a new method has been proposed. First, a laser is used for making a small hole for removing the content. Then, the entire cyst is removed with minimal excision technique after 1 month. By this method, the cyst is removed with just a small scar. It provides a good alternative for uninfected cysts, mainly for the cysts located in thick skin areas or for large cysts.
Surgical Technique: After finding the skin conglutination in middle part of anterior cyst wall, carbon dioxide laser is used for making multiple punctures on the affected area, which creates 2-4 mm diameter holes. Parts of cyst contents are being removed from holes with gentle pressure and squeezing. And, if the contents inside cysts are solid, then small curette is being used without damaging the walls and remnants are washed with 0.9% NaCI solution to make sure that all the content inside cyst is removed. Then, the inside wall is sterilized with povidine-iodine solution and the patient is advised to take antibiotics regularly.
After 1 month, the cyst wall becomes small. The formerly healed wound is incised to a 3-5 mm length and the total cyst is being removed easily.
Discussion: Most dermatologists suggest that if the sebaceous cyst removal is indicated, each effort should be made to remove the whole cyst to prevent the recurrence. But, if the patient has large cyst with excision on face, back or neck, then it’s tough to achieve the pleasuring closure. However, the thin-wall cysts often break so they may need to be removed in pieces, with risk of recurrence.
But, the method proposed here also has some advantages. First, the laser is easy to manipulate. The laser hole results in bit bleeding, which gives complete field of vision for operating the affected area. After removal of cyst contents, the capsule is slowly released and crushed to a smaller capsule with little fluid inside. And, the size of scar that is going to stay is only about one-third of that initial cyst diameter.
Cysts are benign lesions of skin and they are often removed due to cosmetic reasons. A conventional wide excision can remove the entire cyst, but with a long scar. While the minimal excision is similar to punch method, it can leave minimal scarring, but the down side is, it carries a huge risk of recurrence. So, for large cysts, the wall is more friable which makes the cyst removal for better appearance becomes more difficult.
Conclusion: The above described procedure produces little or no recurrence, with expected cosmetic results. And, it can be a great alternative for uninfected cysts, especially when the cyst is located in thick skin or it’s a cosmetic concern.