A New Procedure for Treating a Sebaceous Cyst: Removal of the Cyst Content with a Laser Punch and the Cyst Wall with a Minimal Postponed Excision
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Three main techniques are used to excise sebaceous cysts: conventional wide excision, minimal excision, and punch biopsy excision. A new method with two steps is proposed. First, a laser is used to make a small hole for removal of the content. Then the cyst wall is removed entirely with a minimal excision about 1 month later. With this method, the cyst is completely removed with only a small scar. It offers a good alternative for eradication of uninfected cysts, especially large cysts or cysts located in areas of thick skin or cosmetic concern.
KeywordsLaser Minimal excision Sebaceous cyst
Sebaceous cysts are benign lesions of the skin, and cosmetic reasons for removal of cysts in an exposed area are often mentioned. A conventional wide excision can remove the cyst completely but with a potentially long scar. The minimal excision technique is similar to the punch technique, which can achieve minimal scarring but carries a risk of recurrence [1, 2, 3]. For large cysts or cysts located in areas of thick skin, the cyst wall is more friable or not easy to express, making complete cyst removal with a better cosmetic appearance more difficult.
Combining the advantages of two methods, we proposed a new method with two steps. First, a laser is used to make a small hole for removal of the cyst content. Then the cyst wall is removed entirely with minimal excision about 1 month later. We have treated 12 sebaceous cysts with this method successfully since 2006.
About 1 month later, the cyst wall had become small. By using a no. 15 blade, the skin of the formerly healed wound was incised to a length of approximately 3–5 mm, and the total cyst wall was removed easily (Fig. 1d). The incision closed by natural healing in about 1 week (Fig. 1e).
Most clinicians suggest that if cyst removal is desired or indicated, every effort should be made to remove the entire cyst lining to prevent recurrence of the sebaceous cyst . But with excision of a large cyst on the face, neck, or back, it is difficult to achieve an aesthetically pleasing closure . Thin-walled cysts tend to break and may need to be removed in pieces , with the risk of recurrence when the minimal excision technique is used.
The method we propose has some advantages. The laser is easy to manipulate, and the laser hole punch results in little bleeding, giving a clear field of vision for the operating area and no infection. After expulsion of the cyst contents, the capsule is gradually loosened and crumples to a smaller capsule with some fluid inside. Its complete removal is easy in the delayed operation, which allows for dissection and excision under direct vision, providing for confident and complete removal of the cyst wall while minimizing scar length. The length of the resulting scar is only about one-third that of the initial cyst diameter, and for some small lesions on the face, the scar is inconspicuous.
The described surgical procedure produces no recurrence, with favorable cosmetic results. It can be a good alternative for eradication of uninfected cysts, especially large cysts or cysts located in areas of thick skin or cosmetic concern.
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