Benign cyst lined by epidermis containing keratin debris; common on scalp, face, neck, scrotum.
History taking
- • Slow-growing, painless swelling; occasionally discharges cheesy material
- • Episodes of infection — pain, redness, discharge
Examination
- • Spherical, smooth, firm, tethered to skin with central punctum
- • Inflamed/abscessed if infected
Red flags
- • Rapid growth, ulceration, bleeding — exclude malignancy
Differential diagnosis
- • Lipoma, dermoid cyst, neurofibroma, lymph node
Recommended investigations
- • Clinical diagnosis
Diagnosis
- • Clinical
Initial treatment / management
- • Asymptomatic: observation
- • Symptomatic/recurrent infection: complete excision under LA when not inflamed
- • Infected: incision & drainage, antibiotics, plan excision later
Prescription examples
- • Tab Cefalexin 500 mg PO QID x 5 d for infected cyst with cellulitis
- • Post-op simple analgesia
Follow-up advice
- • Wound review 7 days; ensure complete capsule removal to prevent recurrence
Patient counselling
- • Recurrence if capsule incompletely removed
Referral criteria
- • Recurrent or large cysts for definitive surgery
Clinical pearls
- • Central punctum is the diagnostic clue
- • Do not excise during active infection — drain first, excise later
References
- • Bailey & Love's Short Practice of Surgery 28e
Educational outpatient guide — verify against local guidelines before clinical use.
