CYSTS

Description of the procedure and treatment:

Types of cysts:

  • Epidermoid cyst

It is the most common cyst, originating from the distal part of the hair follicle (infundibulum), appearing in the form of round subcutaneous nodules and tumours ranging in size from a few millimetres to a few centimetres. It is filled with a mixture of keratin, sebum and cholesterol, often with a hole perceptible at the top, which is a remnant of the clogged follicle. Cysts may become infected. They occur mostly on the face, but other locations are also possible. Treatment involves the excision of the whole sac, since leaving it may result in the regrowth of the cyst. The most common excision procedure involves a straight incision and in the case of excess skin - a spindle-shaped incision on top of the tumour, along the lines of skin tension (Langer’s lines). It is worth trying to remove the sac through a small hole made by a biopsy punch or a 5-mm incision, after the content has been squeezed out, which leaves only a tiny scar. When infected, cysts become hot, red and painful. Infected cysts should be incised in order to drain the content and their excision should be deferred until the resolution of inflammation.

  • Milium, milia

A small, subcutaneous cyst of 1-3 mm in diameter appearing in the form of tiny white nodules, not connected to the surface of the skin. Milia can develop spontaneously, as a result of various injuries or sun damage. They occur most frequently on the face. The treatment involves an incision with a scalpel no. 11 or a needle and picking out the content of the cyst, possibly with a special extractor. Eradicating multiple milia is easier with prior removal of the superficial layer of the skin (dermabrasion).

  • Blackhead (comedo)

A small cyst caused by over-proliferation of keratinocytes which clog follicles. Takes the form of minuscule nodules composed of sebum and keratin masses excreted to the surface of the skin, blackened at the top as a result of oxidation process. Blackheads are formed in seborrheic areas containing multiple sebaceous glands: the face, sternum and back areas. The treatment involves removing the content, possibly with the sac, after the initial softening. Comedolytics (retinoids, benzoyl peroxide, azelaic acid) may be applied topically. In the systemic treatment synthetic derivatives of vitamin A are also used.

  • Dermoid cyst (cystis dermoidalis)

It is a congenital (developmental) subcutaneous cyst formed in the place of germinal epithelium junction, manifested in childhood. The cyst occurs in the form of a dome-shaped, subcutaneous nodule with a diameter of 0.5-5 cm, usually on the face, especially around the eye sockets, the midline of the nose and neck, the retroauricular region, less frequently on the genitals. The treatment consists of surgical excision.

  • Cyst of oral mucosa (cystis mucosae oris, mucocele)

It is a transparent nodule bluish in colour, which develops within the oral mucosa. It belongs to the pseudocysts family. The lesion results from a damage to the secretory duct, usually on the mucous membrane of the lower lip.

  • Synovial cyst (cystis synovialis, ganglion)

A frequently occurring subcutaneous tumour developing as a result of the herniation of the synovial membrane. It is a soft and elastic tumour up to 3 cm in diameter, covered with intact skin, developing over the joints.

Location: joint areas, most frequently the wrist, knee, and the popliteal area (Baker's cyst).

Treatment: Surgical excision – the incision should reach the mouth of the cyst in the joint capsule, which can pose difficulties. Nevertheless, leaving some remains of the sac may lead to the regrowth of the cyst.

  • Digital mucous cyst (cystis mucoidalis digitorum, myxoid digital cyst)

It is a type of ganglion located over the small joints. It occurs as a small, sometimes painful, flesh-coloured translucent lump with gelatinous content, often accompanied by a longitudinal nail groove.

Location: dorsal surface of the distal parts of digits, especially in the proximal nail fold area and the distal interphalangeal joint area, less frequently on the toes.

Treatment: Surgical excision, partly along with the skin covering the cyst, is easier after the intracystic injection of, for e.g., methylene blue. The base of the cyst, which may be linked to the distal interphalangeal joint, should be removed. Closure of the defect may be performed by means of the transposition flap, leaving the postoperative defect to heal spontaneously.

  • Pilar cysts (tricholemmal cyst, cystis pilaris)

A cyst stemming from the outer root sheath of the hair follicle. Pilar cysts are common, dome-shaped, soft, elastic nodules of 0.5-4 cm in diameter, located on the scalp. Nodules are often multiple, with higher prevalence in women, and often run in the family.

Treatment: Surgical excision.

Postoperative recommendations:

In the case of postoperative wounds – proper wound care with suitable agents and protection against inflammation.

The period of incapacity for work:

The procedure does not require absence from work.