Epidermoid cysts

Aka sebaceous cysts

• Most common cutaneous cysts
• Contain a cheesy keratin material
• Most common on face, scalp and trunk
• Various options for removal

Differential diagnosis

• Pilar cyst (trichilemmal cyst) - suspect if seen on scalp - remove in same way
  • If less cystic and more hard/bony, suspect pilomatrixoma

Standard dissection

• Incise an ellipse over the cyst, including the central punctum
• Apply forceps (?Allis) to the skin to provide retraction
• Use scissors to dissect free of adherent dermis and subcutaneous tissue, avoiding rupture
• Obliterate space with subcutaneous sutures
• Close skin with vertical mattress to invert skin edges into slack wound

Incision: (best for infected cysts - may not be able to close)

• Just incise into it and squeeze out the contents
• Use a gauze swab to avulse the lining
• Curette
• Close

Punch biopsy

• Do a small punch
• Squeeze out
• Avulse lining
• Can close if desired

Incision over cyst and blunt dissection

• Make an incision over cyst
• Use scissors to gradually dissect it out
• 'Pop' it free