Clinical Hours: Mon-Fri, 8AM - 3PM(905) 493-5700
1885 Glenanna Road, Suite 220, Pickering, ON, L1V 6R6
Surgical removal of epidermal and pilar cysts, including complete excision of the cyst wall to prevent recurrence and address infection, discomfort, or cosmetic concerns.
Skin cysts are enclosed sac-like structures within the skin that contain fluid, semi-solid material, or keratinous debris. While most cysts are benign and slow-growing, they may become problematic when they enlarge, become inflamed or infected, cause pain, or are cosmetically bothersome. Surgical excision is the definitive treatment for skin cysts and is performed as an outpatient procedure under local anaesthesia.
Epidermoid cysts are the most commonly encountered type of skin cyst. They arise from the infundibulum of the hair follicle and are lined by stratified squamous epithelium that produces keratin. These cysts present as firm, round, subcutaneous nodules, often with a visible central punctum on the skin surface. They may occur anywhere on the body but are most frequently found on the face, neck, trunk, and upper back.
Pilar cysts, also known as trichilemmal cysts, originate from the outer root sheath of the hair follicle. They occur most frequently on the scalp and tend to run in families. Pilar cysts are typically smoother and firmer than epidermoid cysts and lack a central punctum. Multiple pilar cysts may be present simultaneously.
Dermoid cysts are developmental cysts that are present from birth, although they may not become apparent until later in life. They arise from entrapment of skin elements along embryonic fusion lines and may contain hair, sebaceous material, and other tissue components. Dermoid cysts are most commonly found around the eyes, on the forehead, or along the midline of the body.
Cyst removal is recommended when a cyst becomes recurrently inflamed or infected, causes pain or tenderness, continues to enlarge, is located in an area subject to friction or pressure, or is cosmetically unacceptable. Removal may also be advised when there is diagnostic uncertainty, as excised tissue is submitted for histopathological examination to confirm the nature of the lesion.
Surgical excision of a cyst is performed under local anaesthesia. An elliptical incision is made over the cyst, typically incorporating the central punctum when present. The cyst is carefully dissected free from the surrounding tissue, with particular attention given to removing the cyst wall in its entirety. Complete removal of the cyst wall is essential, as any residual lining left behind may lead to recurrence.
Following excision, the wound is closed in layers using absorbable deep sutures and non-absorbable skin sutures. The excised specimen is sent to a pathology laboratory for histopathological examination. The procedure is well tolerated and typically completed within 20 to 40 minutes depending on the size and location of the cyst.
When a cyst becomes acutely inflamed or infected, it may present as a red, swollen, painful nodule. Definitive excision of an actively inflamed cyst is generally avoided, as the inflamed tissue planes make complete removal of the cyst wall difficult and increase the risk of recurrence and wound complications.
In these cases, the initial management involves incision and drainage to relieve pressure and allow the acute inflammation to subside. Antibiotics may be prescribed if secondary bacterial infection is present. Once the inflammation has fully resolved, typically after four to six weeks, a planned excision is performed to remove the cyst wall and prevent future episodes.
Following cyst excision, the surgical site should be kept clean and dry for the first 24 hours. Thereafter, gentle cleansing and application of petroleum jelly or prescribed ointment is recommended until suture removal. A pressure dressing may be applied to reduce the risk of haematoma formation, particularly for larger cysts. Sutures are typically removed within 7 to 14 days, depending on the anatomical location.
Patients are advised to avoid heavy lifting and strenuous exercise during the initial healing period to minimize wound tension. Mild soreness and bruising are common and resolve within the first week. The resulting scar fades progressively over several months, and sun protection of the area is encouraged to prevent hyperpigmentation.
Dr. Maksym Breslavets at the Centre for Medical and Surgical Dermatology performs cyst excisions with a focus on complete removal of the cyst wall to minimize the risk of recurrence. Each procedure is tailored to the individual case, with careful attention to wound closure and cosmetic outcome.
Your feedback helps us improve our service information
The Centre for Medical and Surgical Dermatology provides comprehensive care across all areas of dermatology. To schedule a consultation with Dr. Breslavets, please obtain a referral from your healthcare provider.