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The Internet Journal of Plastic Surgery

Volume 7 Number 1

Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide

S Shah, R Wain, S Syed
Citation

S Shah, R Wain, S Syed. Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide. The Internet Journal of Plastic Surgery.
2009 Volume 7 Number 1.
Abstract
Excision of a sebaceous cyst is a common procedure carried out in plastic and general surgical departments and in general
practice. The cyst should be excised completely in order to avoid recurrence. If the cyst ruptures during the procedure there is
an increased infection risk and recurrence rates are higher. Several methods have been employed for excising sebaceous cysts
but none guarantee complete excision without rupture 1, 2, 3, 4, and some techniques advocate it 5. We describe in detail a
technique which dramatically reduces the occurrence of cyst rupture.

INTRODUCTION
We demonstrate a step-by-step pictorial guide of the method
we follow to excise sebaceous cysts. This technique
minimizes the probability of cyst rupture due to minimal
direct handling of the cyst itself. This method, if carried out
correctly, is effective in ensuring that all cyst contents and
the cyst wall are removed.

METHOD
STEP-BY-STEP GUIDE
1. Palpate the cyst and surrounding area to confirm its
exact location and punctum. (Image 1)
2. Draw an ellipse around the punctum over the cyst
with a skin marker. The longitudinal direction of
the ellipse should be in the direction of the natural
skin creases. (Image 2)
3. Infiltrate local anaesthesia using 2% Lignocaine
with adrenaline.
4. Clean with anti septic solution. e.g. Betadine /
Chlorhexadine.
5. Cover the skin around the site of the cyst with
sterile drapes. (Image 3)

8. Once this plane is identified separate the

superficial 25% of the circumference of the cyst
with blunt dissection.
9. Now press the normal surrounding skin and soft
tissues on both sides gently with the thumbs, first
in one direction, then at 90 degrees to the previous
direction. (Images 6 & 7)
10. Around 80-90% of the cyst emerges from the
incised area.
11. Gently lift up the incised ellipse of skin and
attached cyst with forceps, and separate the deep
pole of the cyst from underlying tissues using
scissors. (Image 8)
12. Ensure haemostasis and close the skin with non
absorbable interrupted sutures. e.g. 6/0 Ethilon.
(Image 9)
13. Clean the wound with saline solution and dry.
14. Apply steristrips and skin coloured tape.

IMAGES

6. First incise the skin up to the subcutaneous tissues

using a scalpel (Image 4).
7. Then, using blunt and sharp dissection, identify the
plane between the cyst and surrounding
subcutaneous tissues. (Image 5)

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Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide

Figure 1

Figure 4

Image 1

Image 4

Figure 2

Image 2

Figure 5

Image 5

Figure 3

Image 3

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Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide

Figure 6

Figure 8

Image 6

Image 8

Figure 7

Figure 9

Image 7

Image 9

DISCUSSION
Sebaceous cysts are benign, firm to fluctuant lesions that
often occur behind the ears, on the face, neck, scalp, trunk
and scrotum. They have a dark keratin plug overlying the
cyst cavity and are usually mobile on palpation. They can
range from a few millimetres to a few centimetres in
diameter and their contents are a thick, foul smelling
combination of keratin and lipids 6, 7. The most common
cause of a sebaceous cyst is rupture of a pilosebaceous
follicle associated with acne. Other causes include a
developmental defect of the sebaceous duct or traumatic
implantation of surface epithelium beneath the skin 6, 7.
We are not aware of another step-by-step pictorial guide for

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Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide

this novel technique. The method described is effective in
removing the cyst while ensuring it stays intact however, if
handled roughly the cyst wall may still rupture.

References
1. Suliman MT. Excision of epidermoid (sebaceous) cyst:
description of the operative technique. Plast Reconstr Surg
2005;116:2042-3.
2. Nakamura M. Treating a sebaceous cyst: an incisional
technique. Aesthetic Plast Surg 2001;25:52-6.
3. Moore C, Greer DM, Jr. Sebaceous cyst extraction

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through mini-incisions. Br J Plast Surg 1975;28:307-9.

4. Humeniuk HM, Lask GP. Treatment of benign cutaneous
lesions. In: Parish LC, Lask GP, eds. Aesthetic dermatology.
New York: McGraw-Hill, 1991:39-49
5. Zuber TJ. Am Fam Physician. 2002 Apr 1;65(7):1409-12,
1417-8, 1420
6. Cruz AB, Aust JB. Lesions of the skin and subcutaneous
tissue. In: Hardy JD, Kukora JS, Pass HI, eds. Hardy's
Textbook of surgery. Philadelphia: Lippincott, 1983:319-28.
7. Domonkos AN, Arnold HL, Odom RB. Andrews'
Diseases of the skin: clinical dermatology. 7th ed.
Philadelphia: Saunders, 1982.

Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide

Author Information
S H A Shah, MBBS, FRCSI
Registrar in Plastic & Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Royal Preston Hospital
R A J Wain, MBChB
CT1 in Plastic & Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Royal Preston Hospital
S Syed, MBBS
Department of General Surgery, St Luke`s General Hospital

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