management

Last reviewed 09/2021

If an epidermoid cyst is infected, it should first be incised, drained and cultured. If drainage fails to resolve the infection, antibiotics should be started. Empirically, an anti-Staphylococcal agent is used if cultures and sensitivities are delayed as this is tne most common infecting organism. Formal removal of the cyst should only be attempted once infection and inflammation have settled.

A non-infected cyst may be removed under local anaesthetic. Providing it is well-encapsulated, usually it is possible to enucleate a large cyst through a small incision with adequate retraction. One should attempt to keep dissection flush with the cyst wall to prevent damage to surrounding structures. The tension of the cyst contents helps with identification; if the cyst ruptures during removal, it is worth attempting to suture the hole to retain the residual contents. Conversely, when attempting to remove a very large cyst, aspiration of some of the contents at the beginning may make it easier to deliver through a small incision.

All the lining of the cyst must be removed to ensure that it will not recur.