What is a Skin Cyst?
A Skin / Epidermal Cyst, commonly known as a Sebaceous Cyst, appears as a superficial bluish-grey skin lump that tends to bulge onto the skin. It is often associated with a small bluish pin-point dot on the surface which corresponds to a punctum. A skin cyst is a benign and non-cancerous cyst.
A Skin / Epidermal Cyst is commonly known as a Sebaceous Cyst. The term ‘Sebaceous Cyst’ is actually incorrect as it erroneously refers to the origin as the sebum glands while the term ‘Skin / Epidermal Cyst’ is the medically correct term as the actual cyst arises from the follicular infundibulum which is part of the epidermal layer of the skin.
A Skin Cyst arises from the follicular infundibulum, which is one of the cell layers forming the skin. The cyst contains a cheesy greyish material which is composed of Keratin, one of the components of the most superficial layer of the skin. The cyst contents are encapsulated by a thin layer of cyst wall formed by the follicular infundibulum.
Skin cysts can occur any part of the skin, including the face, torso, and limbs. It can occur singly or in multiples spread over different parts of the body. Skin cysts should not be painful or tender.
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What is the difference between an Epidermal and Trichilemmal Cyst?
An Epidermal Cyst and a Trichilemmal Cyst are similar in appearance. They both appear as superficial skin lumps that are easily palpable. There are two main differences between these two types of cysts, namely the cell origin and the location that they manifest.
Epidermal cysts can occur on any part of the skin, but Trichilemmal cysts occur almost exclusively on the scalp. In contrast to Epidermal Cysts, Trichilemmal cysts arise from the root sheath of the hair follicle, which is essentially the base of the scalp hair.
The subsequent discussion on Skin Cyst applies to Trichilemmal cysts too.
Can I leave my Skin Cyst alone? Will it turn Cancerous?
Skin cysts are benign and do not become cancerous. However, this assessment can only be made when the lump is removed and undergoes a histological examination (microscopic examination).
Must I remove my Skin Cyst? Can I leave it alone?
A skin cyst can be considered for removal if the cyst is causing inconvenience to the individual, if infected or if the individual just wants it removed for peace of mind and histological assessment.
A cyst, particularly if enlarged, can cause inconvenience while doing daily activities. The cyst can catch on clothing or jewellery. In addition, a cyst may get bumped on during daily activities or when on crowded public transport.
Skin cysts can also get inflamed with subsequent secondary bacterial infection. Cysts get inflamed if a hard knock had or if an individual had it squeezed, causing the keratin contents to leak out and irritating the skin. An inflamed cyst can easily swell up to twice its usual size or larger with a red and angry appearance. At this stage, it can potentially be secondarily infected by bacteria with the formation of pus.
It is perfectly reasonable to leave a small cyst alone. However, it is important to be aware that a cyst, unlike pimples or comedones (whiteheads and blackheads), must never be squeezed or have any attempt made to express it. The keratin contents, as mention above, will lead to inflammation and infection.
How is the Skin Cyst removal carried out?
Most skin cyst excisions are carried out under local anaesthesia as the cyst is usually located superficially in the skin. It is important that the cyst is removed in its entirety with no cyst wall remaining behind. Any cyst wall that is left behind can lead to a recurrence of the cyst.
Local anaesthesia is injected around the cyst to allow the surgery to be carried out. An incision is made over the cyst, taking care to include the punctum (bluish pin-point) which is part of the cyst wall that is attached to the skin surface. The cyst is then dissected out carefully and removed in its entirety. The skin is then sutured with absorbable sutures that do not require removal of stitches. The skin will usually have united quite nicely by the two-week mark.