He was a big guy but he was hurting when he walked in the door. “I have a very sore lump on my back, it’s draining some stuff that smells terrible” was what he told me and I agreed. He had a skin cyst that needed surgical intervention and he had come to the right place.
Skin cysts are sometimes no problem and sometimes they are problems that need a minor surgical procedure. They are just sacs located just under the skin surface that have an outer wall and an inner “filling” with liquid or semi-solid material. Most skin cysts are called Epidermoid cysts (commonly called Sebaceous cysts) and are filled with a thick, foul-smelling protein called keratin. They are prone to infection with Staph skin bacteria that normally inhabits the skin. They are not cancer, they are not life-threatening but they can be bothersome especially if they become infected and an abscess forms around the cyst.
So here’s what I did…
Like any pus that’s trapped in a closed space, it needed to be surgically drained. I numbed the skin around the cyst with local anesthesia and made an incision right over the cyst/abscess and drained the infection and removed as much of the cyst and it’s wall as possible. A small wick was placed in the wound to keep it open and the patient did well. Antibiotics were given after the procedure was done.
But what of the person who comes in with a cyst that’s not infected, is it removed too?
Skin cysts are excised if they are getting larger, causing pain, if they occur in an area that is constantly irritated or is cosmetically unacceptable (and that covers a good share of them). The procedure is the same but if there’s no infection, the wound can be stitched closed and no drain/wick is placed. The key to cyst surgery is to remove the whole cyst… the contents and the wall. The cyst can return if the wall is not removed. Just removing the contents and not the wall is a common mistake made by non-surgeons.