Epidermoid cyst in Paris

Recognising an epidermoid cyst

a "lump" under the skin, firm or soft, mobile, slow-growing;
often a small visible central opening (punctum), through which whitish material may discharge;
possible episodes of inflammation: the cyst becomes red, painful, increases in size, and sometimes becomes infected.

The diagnosis is clinical in most cases; any atypical lesion warrants a dermatological opinion, and the removed specimen is systematically analysed.

Why remove it?

An epidermoid cyst does not disappear spontaneously. Excision is considered when the cyst:

increases in size or becomes unsightly;
causes mechanical discomfort (rubbing from clothing, shaving, pressure);
becomes repeatedly inflamed or infected;
or when diagnostic doubt warrants analysis.

The key point of the procedure is complete removal of the cyst wall: it is the wall that produces the cyst's contents, and its complete removal is what prevents recurrence.

The procedure

Local anaesthesia, as day surgery, in the great majority of cases.
A short incision, orientated along the skin creases, centred on the cyst.
Dissection and removal of the cyst in its entirety, wall included.
Closure with sutures; the specimen is sent to the laboratory for analysis.

The procedure generally takes 20 to 40 minutes depending on size and location.

Special case: the inflamed or infected cyst

A cyst is not operated on "hot": inflammation makes dissection of the wall incomplete and increases the risk of recurrence and of a poor-quality scar. In the event of infection, immediate treatment may involve local care, medical treatment, and sometimes a drainage incision; complete excision is then scheduled at a later date, once the inflammation has resolved.

Recovery and healing

Recovery is straightforward: a dressing for a few days, sutures removed or dissolvable depending on the area, minimal discomfort. The scar, which is short, fades gradually. If a scar remains bothersome, a revision or suitable treatment can be discussed later on.

Recognising an epidermoid cyst

a "lump" under the skin, firm or soft, mobile, slow-growing;

often a small visible central opening (punctum), through which whitish material may discharge;

possible episodes of inflammation: the cyst becomes red, painful, increases in size, and sometimes becomes infected.

The diagnosis is clinical in most cases; any atypical lesion warrants a dermatological opinion, and the removed specimen is systematically analysed.

Why remove it?

An epidermoid cyst does not disappear spontaneously. Excision is considered when the cyst:

increases in size or becomes unsightly;

causes mechanical discomfort (rubbing from clothing, shaving, pressure);

becomes repeatedly inflamed or infected;

or when diagnostic doubt warrants analysis.

The key point of the procedure is complete removal of the cyst wall: it is the wall that produces the cyst's contents, and its complete removal is what prevents recurrence.

The procedure

Local anaesthesia, as day surgery, in the great majority of cases.

A short incision, orientated along the skin creases, centred on the cyst.

Dissection and removal of the cyst in its entirety, wall included.

Closure with sutures; the specimen is sent to the laboratory for analysis.

The procedure generally takes 20 to 40 minutes depending on size and location.

Special case: the inflamed or infected cyst

Your questions, our answers

Can the cyst come back after the operation?

If the wall has been removed in its entirety, recurrence is rare. This is precisely the advantage of complete surgical excision over simple evacuation of the contents, which almost always leads to recurrence.

Can an infected cyst be removed?

Not at the same time. The inflammatory or infectious episode is treated first, then the cyst is removed "cold", under good conditions. This strategy gives better results and a better scar.

Is the procedure painful?

No: it is performed under local anaesthesia. Moderate tenderness of the area for a few days is usual and easily controlled.

Is the content of the cyst analysed?

Yes, the excised specimen is systematically sent for histopathology. This is a safety rule, even for a seemingly unremarkable lesion.