Sebaceous Cyst Excision

What is Sebaceous Cyst (Pilar cyst or Epidermoid Cyst)?

Sebaceous cyst is a term used to describe both pilar or epidermoid cysts. They very rarely arise from sebaceous glands but often from hair follicles or the epidermis. They are benign and do not have to be excised. However, they do tend to grow, making the incision larger the longer you wait. They can also cause pressure symptoms, become infected or form an abscess.

The surgery is performed through a scar that is as small as possible and contains the punctum connecting the cyst to the skin. The length of the scar is dictated by the size of the lesion. On rare occasions, the cyst may return, or a new one grows, which will result in further surgery.

The operation can be performed under local anaesthetic injection (you are awake, but the area is numb) or general anaesthetic (you will be fully unconscious).

Most commonly it is performed under local anaesthetic in the procedure room in Cayman Surgery. The affected area is numbed with an injection, and the procedure takes approximately 40 minutes to perform.

The risks and complications of skin lesion excision are scar (stretched, thin, thick, pigmented, hypertrophic/keloid), infection, bleeding, damage to deeper structures, recurrence, asymmetry, distortion of local structures, tightness, pain, abnormal histology, further excisions, allergic reaction, unsatisfactory result, dog-ears, wound healing problems and dehiscence.

Having surgery should be a very positive experience.

Complications are infrequent and usually minor. However, all surgery has risk, and it is important that you are aware of the possible complications. All the risks will be discussed in detail with you at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me. Decisions about surgery should never be rushed.

These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

  • Unintended intraoperative awareness, which is very rare.
  • Dizziness and nausea.
  • Sore throat.
  • Damage to teeth or mouth.
  • Nerve injury due to body positioning.
  • Allergic reaction or anaphylaxis.
  • Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: These tend to settle remarkably well; however, some people heal with thicker scars than others and this can make them more noticeable.

Bruising and swelling: This is very common and may take approximately 2 weeks to resolve.

Haematoma: This can happen if a bleed occurs under the skin, allowing a large blood clot to form. If a haematoma develops, it is likely to do so within 4 to 6 hours post-surgery. Any increase in swelling or pain should be reported immediately so that timely treatment can be given. Sometimes patients need to have this collection of blood removed with another short operation.

Infection: This is rare, but you may require antibiotics if there are any concerns.

Numbness, reduced sensation or oversensitivity: These can occur around the scar. They are usually temporary, but occasionally the changes can remain to some degree.

Wound healing problems: These healing difficulties can range from minor problems, such as small areas of wound separation, to major issues, resulting in skin loss. People who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Some patients may wonder why it is important to stop smoking before, during and after surgery? This is simply because of the nicotine itself and not the cigarette (please see the conclusion from this science journal – https://bit.ly/2C5gTE3).

Dog-ears: These are soft tissue prominences where the scar stops. In most cases these settle over the course of 3 months. A small local anaesthetic procedure may be required to remove any excess that remains.

Recurrence: Even when a lesion is completely excised, it is possible that it could recur, or a new one can grow in the area.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. To reduce any risks of this, we may give you special stockings to wear in bed and a blood thinning injection if you are not mobile.
All the risks outlined above will be discussed in detail at your consultation with me. However, if you have further questions or concerns, please do not hesitate to ask.

Depending on the area of your surgery, your incisions are closed with either dissolvable or non-absorbable sutures.

Dissolvable sutures under the skin do not require removal whereas the non-absorbable sutures will need to be taken out after 5 days. You normally have a waterproof dressing to enable you to shower.

Before you leave the clinic, you will be given a follow up appointment to see the nurses at one week post-operatively to check your incisions and an appointment to see me in Clinic 2 weeks’ time.

Scar Advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

Recovery times vary from one person to another, but most patients return to work the next day. I recommend that you avoid swimming and strenuous activities for 1 to 2 weeks.

Many patients having skin lesion removal are covered by health insurance. However, there is normally a co-pay of 20%. This means you are likely to have to pay towards the cost of your surgery. Any fees will be calculated, and you will be informed of the potential fees at your consultation.

For self-funding patients, surgical fees are a combination of the hospital costs, the surgeon, anaesthetic fees (if required) and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.