Dermatology Online Journal

Excision of epidermoid cysts with a minimal linear incision
Krishna Rao MCh MRCSEd, and Hamid Tehrani MBBS MRCSEd
Dermatology Online Journal 12 (1): 21

Department of Plastic Surgery, Royal Preston Hospital, Preston, Lancashire, United Kingdom. krisrao@doctors.net.uk

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Excision of epidermoid cysts is a common procedure and may be performed via conventional, punch, or minimal excision techniques. The conventional technique allows for excision without rupture of the cyst wall, through an incision of approximately the same diameter as the cyst. This allows for complete cyst excision with ample exposure, but at the expense of a potentially long scar. The punch technique allows for extrusion of the cyst contents through a 3-4 mm skin and cyst opening created by a punch biopsy tool. The deflated cyst can then be pulled through the skin aperture and excised; this technique carries a recurrence rate of approximately 6 percent [1]. The minimal excision technique utilizes a 2-3 mm incision to excise the cyst following extrusion of contents in a similar manner to the punch technique [2, 3].

Figure 1	Figure 2

We have found these latter two methods to be unsatisfactory, however, because they carry a significant risk of inadvertently leaving cyst remnants in the wound due to limited exposure. We find that an incision of approximately one-third the cyst diameter (Fig. 1) will allow for dissection and excision under direct vision, confidently providing for complete removal of cyst contents and wall whilst minimizing scar length (Fig. 2). After making the incision we evacuate the cyst contents by suction after injection some normal saline. Although cyst contents are uninfected we recommend a thorough wound wash before closure. We remind readers to consider the use of such minimal excision techniques and advocate the method described by our group.

References

1. Mehrabi D, Leonhardt JM, Brodell RT. Removal of keratinous and pilar cysts with the punch incision technique: analysis of surgical outcomes. Dermatol Surg 2002; 28:673-7

2. Zuber TJ. Minimal excision technique for sebaceous (epidermoid) cysts. Am Fam Physician 2002; 65:1409-12, 1417-8, 1420

3. Nakamura M. Treating a sebaceous cyst: an incisional technique. Aesthetic Plast Surg 2001; 25:52-6

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