Sebaceous Cysts: Diagnosis, Treatment, and When to Seek Surgery

Sebaceous cyst

Hello, doctor.
I am currently abroad, and the medical process I am undergoing is not by my choice; it is dictated by the local system.
In recent years, I have experienced multiple occurrences (every 2-3 months) of a lump near the groin area on my right thigh, which appears to be swollen.
The skin is intact, with no rupture or pus discharge, and it usually resolves on its own in about 10 days.
I typically notice it while showering, and it does not affect my mobility.

Until last November, when I was awakened at night by pain and experienced radiating pain, numbness, and cramping in my limbs, with a sharp pain that was intolerable even with clothing touching the area.
I eventually sought medical attention (for the first time) and was diagnosed with an atheroma (sebaceous cyst).
I was referred for surgery, but the surgeon declined to operate, stating that there was inflammation or infection present.
I was instructed to return to the original referring physician for surgery arrangements in a week.
Although he mentioned that surgery was the only option, he did not schedule the follow-up procedure and advised me to return if the situation recurred.
I then consulted a different physician, and by that time, the swelling had begun to decrease and was no longer painful (I had taken photos of the affected area previously).
The new doctor reviewed my prior medical records and confirmed the diagnosis of an atheroma (sebaceous cyst).
Surgery was deemed possible, and I scheduled a procedure.
However, on the day of the surgery, the surgeon (who I met for the first time) examined the area and determined that the lump had shrunk too much and that the area was sensitive (due to numerous blood vessels), making surgery inadvisable.

Over the course of about a month, aside from showing the doctor the affected area, I received no medication or treatment.
They rarely use antibiotics.
Now, on February 8, 2013, the same area has developed a similar lump again (though it is not as intensely painful as before, it resembles previous occurrences).
However, there is tenderness and a sensation of swelling upon pressure, and I suspect it is the same issue.

My questions are: What exactly is this? Is the diagnosis of atheroma (sebaceous cyst) correct? The "redness and swelling" often indicate an inflammatory response, yet they do not operate during inflammation, and if the swelling is too small, they also do not operate.
When would be the appropriate time for surgery? Thank you for your explanation.

Xiao Wang, 30~39 year old female. Ask Date: 2013/02/08

Dr. Wu Yuxin reply Dermatology

It should indeed be a sebaceous cyst or an epidermoid cyst.
The management principles are as follows: 1.
When there is redness and inflammation, the primary focus should be on anti-inflammatory treatment, such as local injections or oral medications; surgery is not advisable at this stage.
2.
Once the condition returns to normal, it is the appropriate time for surgical excision.

Reply Date: 2013/02/08

More Info

Sebaceous cysts, also known as epidermoid cysts or atheromas, are common benign skin lesions that can occur anywhere on the body, including the groin area. They are typically filled with keratin, a protein found in skin, hair, and nails, and can appear as small, round lumps beneath the skin. Your description of recurrent swelling and tenderness in the same area suggests that you are indeed dealing with a sebaceous cyst.

The diagnosis of a sebaceous cyst is usually made through a physical examination. In some cases, imaging studies such as ultrasound may be used to confirm the diagnosis and assess the cyst's characteristics. It is important to differentiate a sebaceous cyst from other conditions, such as abscesses or tumors, which may require different management strategies.

Regarding treatment, the approach to managing sebaceous cysts depends on several factors, including the size of the cyst, the presence of symptoms, and whether there is any sign of infection. In your case, the cyst has been recurrent and has caused discomfort, which is a valid concern.
1. Inflammation and Infection: When a sebaceous cyst becomes inflamed or infected, it can lead to redness, swelling, and pain. In such cases, the first step is often to manage the inflammation. This can be done through the use of anti-inflammatory medications or, in some cases, antibiotics if there is a bacterial infection. Surgical intervention is typically avoided during active inflammation to reduce the risk of complications.

2. Surgical Intervention: Surgery is generally considered the definitive treatment for sebaceous cysts, especially if they are symptomatic or recurrent. The ideal time for surgery is when the cyst is not inflamed and has returned to its baseline size. This is because operating on an inflamed cyst can lead to incomplete removal and a higher chance of recurrence. If the cyst is too small or sensitive, as noted by your surgeon, it may not be practical to proceed with surgery at that time.

3. When to Seek Surgery: You should consider surgery if the cyst:
- Causes significant pain or discomfort.

- Shows signs of infection (increased redness, warmth, or pus).

- Grows larger or changes in appearance.

- Recurs frequently, as in your case.

4. Post-Surgical Considerations: After surgery, there is a possibility of recurrence, especially if the cyst wall is not completely removed. However, if the cyst is excised properly, the chances of recurrence are significantly reduced.
5. Self-Care and Monitoring: If the cyst is not causing significant issues, some patients choose to monitor it. However, if you notice changes in size, increased pain, or other concerning symptoms, it is advisable to seek medical attention promptly.

In summary, your diagnosis of a sebaceous cyst seems accurate based on your symptoms and the medical evaluations you've undergone. The management of such cysts involves careful monitoring, addressing inflammation when present, and considering surgical options when appropriate. It is crucial to communicate openly with your healthcare providers about your symptoms and concerns, as they can guide you on the best course of action tailored to your specific situation.

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