Sebaceous cyst: when should it be removed?

Sebaceous cysts are small lumps of white to yellow colour that primarily develop on the face, back, and chest, areas rich in sebaceous glands. The causes of these growths are numerous and still poorly understood. Most develop following a trauma or a skin condition such as acne. As their name suggests, the formation of sebaceous cysts is closely linked to the hair-sebaceous follicles and results from a rupture of these structures due to an accumulation of sebum or keratin. Although there is a chance that a sebaceous cyst may disappear on its own, this is not always the case.

Without treatment, sebaceous cysts can become permanent, and may even grow over time. That's why it is generally recommended to remove them as soon as they appear.

There are several reasons that may necessitate the immediate removal of a sebaceous cyst, including:

• The daily discomfort caused by a sebaceous cyst.

  Depending on its location, a sebaceous cyst can be a daily nuisance. Indeed, when it is located in an area of friction, such as around the waistband, bra strap, or on the back, it can be irritated by clothing and become painful. This friction also increases the risks that the cyst may rupture and become infected. Moreover, as the sebaceous cyst enlarges, it can press on nerves and muscles, leading to a constant localized mild pain.

• The risks of infection presented by a sebaceous cyst.

  While some sebaceous cysts may remain stable for several months, it is quite common for them to become infected when they are handled or rubbed, against clothing for example. Once infected, a sebaceous cyst can become red, hot, and painful and increase in size. The infection often also manifests itself through the formation of pus within the cyst. When a cyst is infected, a medical intervention becomes necessary, including antibiotics. To avoid this complication, it is preferable to remove the sebaceous cyst before it becomes infected, especially if it is located in an area at risk of frequent handling.

• The aesthetic concerns posed by a sebaceous cyst.

  Another argument in favour of early removal of a sebaceous cyst is the aesthetic damage it causes. When the lump is located on the face, as can be the case for people suffering from cystic acne, or another visible part of the body, its presence can be a source of insecurity or psychological discomfort. Removing the cyst is then the only way to regain clear and uniform skin. Proceeding with the cyst's removal early also minimises the scars left by the procedure. Indeed, the larger a cyst is, the wider the incision needed to remove it will be, which increases the risk of scarring.

• A suspicion of malignancy.

  Removing a sebaceous cyst as soon as it appears also helps to eliminate any risk of malignant skin tumours. If the cyst suddenly changes in size, shape or colour, or if it becomes painful without any apparent reason, a medical consultation is necessary to analyse its nature and ensure there is no risk of skin cancer.

To remove a sebaceous cyst, it is essential to consult a dermatologist. Indeed, although it may be tempting to puncture it oneself, this is a misguided idea that risks causing an infection and increasing the chances of scarring. When the cyst is neither infected nor inflamed, it can be easily and quickly removed by a healthcare professional. The procedure requires local anaesthesia during which the surgeon makes an incision to extract the benign mass before closing the wound. The patient can resume their activities immediately after the operation.

If a cyst is infected or in an inflammatory phase, the operation should be postponed. Indeed, inflammation reduces the effectiveness of local anaesthesia and prevents the dissection of the cyst's capsule, which exposes the patient to the risk of recurrence. Moreover, skin suffering from inflammation heals less effectively. The application of cold compresses, along with the intake of antibiotics, can help to curb the infection.

• ZUBER T. & al. Minimal Excision Technique for Epidermoid (Sebaceous) Cysts. American Family Physician (2002).

• SOLIVETTI F. & al. Sonographic appearance of sebaceous cysts. Our experience and a review of the literature. International Journal of Dermatology (2019).

• MEENA V. & al. Sebaceous cyst: an unusual site of presentation & case report. Global Journal for Research Analysis (2023).