Cysts

What is a skin cyst?

A skin cyst is a round, domed, closed sack-like capsule that is filled with fluid or pus. Cysts are abnormal bumps under the skin that feel like a pea under the skin.  Most are slow growing, painless and harmless and only require treatment if they become symptomatic or infected.

Most cysts are treated because they are painful, increasing in size or infected/inflamed. Treatment may involve injecting steroid medication into the cyst causing it to shrink, but the cyst will still be there.  Draining the cyst removes the contents of the cyst, which will, also make is shrink but will not remove it. Neither of these treatment methods removes the entire cyst, so it therefore may return over time. Only surgically removing the cyst will remove its contents and the cyst capsule. Surgical removal is minor surgery and will leave a small scar, but excision will fully clear the cyst so it will not return.

Common Skin Cysts

Epidermoid cysts (epidermal cysts)

Epidermoid cysts are among the most common benign skin tumors, and they occur more often in men. About 1% of epidermoid cysts have a tendency to become squamous cell or basal cell carcinoma (cancer).  Most of these develop spontaneously, but some arise from genetic disorders such as Gardner Syndrome. In the elderly, an epidermoid cyst can develop from chronic sun damage.

Epidermoid cysts are small, slow-growing lumps that can remain for years. They are commonly found on the face, scalp, upper back, scrotum and genitals, but have been found on the buttocks, fingers and inside the mouth. They are typically flesh colored, tan or yellowish bumps or nodules. If infected, these cysts can become swollen, red, and painful lumps which may rupture and drain pus.

They are typically not sebaceous cysts and do not involve the sebaceous glands. Rather they develop from a buildup of keratin under the skin caused by plugged hair follicles or trauma.  They are symptomless until they rupture. Recent research suggests that some medications, ultraviolet light and infection with Human papilloma virus (HPV) are causes.

An epidermoid cyst can be diagnosed by examination, review of your medical history and the history of the cyst. Frequently, this type of cyst can be diagnosed by exam alone. When the cyst appears abnormal Dr. Heather Higgins  will conduct other tests, for example a biopsy or ultrasound, to diagnose the lesion.

Treatment involves surgical removal, drainage, or injection of a steroid if it becomes infected. Otherwise, these cysts do not require removal, but they will not go away on their own. The most effective treatment is complete surgical removal. Squeezing the cyst is not recommended because it can cause an infection and scarring.

Sebaceous cysts (acne cysts)

Sebaceous cysts are also common benign skin tumors. They are usually small and slow growing, and are filled with sebum, the skin oil made by the sebaceous glands.  They form when the gland becomes blocked. The blockage may be caused by a scratch, a skin condition like acne, or a surgical wound. Some genetic conditions can also cause sebaceous cysts.

Sebaceous cysts can form on the scalp, face, neck and back. The cyst may develop weeks or months after the trauma that caused the blockage. They are typically not painful but when they grow large, they can be uncomfortable. A sebaceous cyst can cause a bad smell, like a foul, cheesy odor.  Large cysts on the face and neck can cause pressure and pain on the tissues. A sebaceous cyst that is larger than 5 cm, reoccurs after removal, or shows signs of infection like redness, pain, and pus drainage are potentially cancerous.

Sebaceous cysts are diagnosed with a visual examination. If we determine the cyst is of concern, she may order imaging studies (ultrasound, CT), or perform a punch biopsy which removes a small amount of the cyst to examine it for signs of cancer. We will recommend the best treatment for your health with consideration of your aesthetic goals.

Treatments for a sebaceous cyst include draining, and surgically removing it. If the cyst is drained but not surgically removed, it often returns. The most effective treatment is complete removal by excision.  After surgery, Dr. Higgins may prescribe an antibiotic to prevent infection.

When you or a loved one develops a lump on the skin, schedule a consultation with Dr. Heather Higgins in Asheville, North Carolina.