Groin Lumps: Keratinous Cysts and Treatment Options

Inguinal mass, sebaceous cyst, skin cyst?

Hello Doctor: About a month ago, I developed a lump in my groin that is approximately 2 cm long and 1 cm wide.
It appears to have some pigmentation, but it is not red, and it is painful when pressed, although it does not hurt when walking.
Two weeks ago, I visited the general surgery department at Taichung Veterans General Hospital, where the doctor diagnosed it as a keratinous cyst, which is commonly referred to as an epidermoid cyst.
The doctor prescribed a two-week course of antibiotics, and during the follow-up visit, he mentioned that if there is no significant inconvenience or severe pain, it can be monitored without surgery.
However, in recent days, since it is located in the groin area, it gets pressed while walking, and it seems to have become inflamed, causing pain.
I would like to ask if it is normal for an epidermoid cyst to be hard and painful.
I recall that epidermoid cysts are usually soft and do not cause much sensation.
Would it be advisable to visit a dermatology clinic for a quicker surgical removal? Thank you for your response!

A Ze, 20~29 year old female. Ask Date: 2023/11/10

Dr. Chen Bingze reply Surgery

Hello, actually, if it sounds like this, you might consider having it removed.
You would feel more at ease; it's a minor surgery that should be performed at some clinics.
You can check nearby clinics for this procedure.

Reply Date: 2023/11/10

More Info

Keratinous cysts, commonly referred to as epidermoid cysts or "pilar cysts," are benign growths that can occur in various parts of the body, including the groin area. These cysts are typically filled with keratin, a protein found in skin cells, and can vary in size. They are often round, firm, and can be tender to the touch, especially if they become inflamed or infected.
In your case, the cyst you described is approximately 2 cm in size and has been causing pain upon pressure, particularly when walking. The presence of pain and the potential for inflammation are important factors to consider. While it is true that many epidermoid cysts are soft and painless, they can become hard and tender if they become inflamed or if there is an infection. The black pigmentation you mentioned could be due to the accumulation of keratin or possibly a sign of a secondary issue, such as a rupture or infection.

The initial treatment your doctor prescribed, which included antibiotics, suggests that there may have been a concern for infection. If the cyst has not improved with antibiotics and is causing discomfort, it may be advisable to consider further intervention. Surgical removal is often recommended for symptomatic cysts, especially if they are painful or have become inflamed. This is typically a straightforward outpatient procedure where the cyst is excised, and the surrounding tissue is closed up, allowing for a more definitive resolution of the issue.

In terms of treatment options, if the cyst is indeed causing significant discomfort and has not responded to conservative management, a referral to a dermatologist or a surgeon specializing in skin conditions would be appropriate. They can evaluate the cyst and determine the best course of action, which may include excision.
It's also worth noting that while many cysts can be left alone if they are asymptomatic, the location in the groin area can lead to increased irritation and discomfort, especially with movement. If the cyst is pressing against surrounding tissues or is in a location where it is frequently irritated, surgical removal may provide relief.

In summary, while keratinous cysts can sometimes be managed conservatively, your symptoms suggest that further evaluation and possibly surgical intervention may be warranted. It is essential to discuss your concerns with a healthcare provider who can assess the cyst's characteristics and recommend the most appropriate treatment based on your specific situation. If you are experiencing increased pain or signs of infection, such as redness, warmth, or drainage, it is advisable to seek medical attention promptly.

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