Cutaneous cyst excision: a practical guide

A step by step guide to cutaneous cyst removal in general practice.

Epidermoid cysts and trichilemmal cysts (or pilar cysts) are epithelial cutaneous cysts that are amenable to removal in the general practice setting.

Epidermoid cysts are common benign tumours and are most often seen in young and middle-aged adults. Clinically they present as firm to fluctuant dome shaped lesions that range in diameter from a few millimeters to 5 cm. Dark keratin puncta may be seen overlying some cysts, and an offensive smelling cheesy material may be discharged through the punctum. The cysts are attached to the overlying epidermis and expand into the underlying dermis and subcutis. The most common locations are the scalp, face, neck and upper trunk.

Trichilemmal cysts occur on the scalp and are more common in women and in middle age. They are clinically similar to epidermoid cysts.