An epidermoid cyst, often called a sebaceous cyst, is a sac under the skin that fills with keratin. Squeezing it empties it and it refills. Removing the sac whole is what stops it coming back. That takes 30 to 45 minutes under local anaesthetic and costs £595.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
An epidermoid cyst is a sac lined with skin cells sitting in the dermis, filling slowly with keratin. It feels firm and round, moves with the skin rather than under it, and often has a small dark central punctum where the sac meets the surface.American Family Physician Zuber, 2002
The common name, sebaceous cyst, is a misnomer that has stuck. The contents are keratin, not sebum. The distinction matters only because it explains why draining one is temporary. The lining keeps producing, so the cyst refills.American Family Physician Zuber, 2002
Most appear on the trunk, neck, face or scalp between the ages of 20 and 60. They form when the opening of a hair follicle blocks and the lining continues to shed inwards. They are not caused by poor hygiene and they are not contagious.American Family Physician Zuber, 2002
An inflamed cyst is usually a rupture rather than an infection. The keratin leaks into the surrounding tissue and the body reacts to it, which produces the same redness, heat and pain an abscess does. Antibiotics alone often do little for that.NICE NG125, 2020
Send us what you are seeing and we will tell you what it is likely to be.
The diagnosis is clinical. The doctor looks for the punctum, checks that the lump moves with the skin, and asks whether it has ever discharged a thick pale material with a strong smell, which is close to diagnostic.American Family Physician Zuber, 2002
Everything removed is sent for histology. It is rare for a cyst to be anything else, and the report is what makes that a fact rather than an opinion. Where a lump is fixed, growing quickly or over 5cm, the pathway changes to imaging or a specialist opinion first.NICE NG12, 2015
Leaving it alone
Reasonable for a small, quiet cyst that does not catch or show. Many stay the same size for years.
Incision and drainage
What an inflamed, tense cyst needs urgently for relief. It empties the cyst and settles the pain, and it leaves the lining behind, so the cyst comes back in most cases.American Family Physician Zuber, 2002
Antibiotics
Useful when there is genuine surrounding cellulitis. They do not remove a cyst and they do not stop it refilling.NICE NG125, 2020
Minimal excision
A small opening, the contents expressed, then the sac teased out through the same hole. A shorter scar than a full ellipse and a higher chance of leaving a fragment behind.American Family Physician Zuber, 2002
Complete excision of the sac
The cyst taken out intact with an ellipse of skin around the punctum and the wound closed. This is what is done here when the cyst is quiet, and it is the version that does not refill. Where the line will sit and what it will look like is agreed before anything starts.General Medical Council GMC guidance, 2020
A quiet cyst takes 30 to 45 minutes to remove. Facial stitches are out on day 7, trunk stitches on day 12 or 14. The scar is red and raised for 6 to 8 weeks and fades over 6 to 12 months, and on the chest, shoulders and upper back it thickens more often than elsewhere.Plastic and Reconstructive Surgery Mustoe, 2002
Where a scar on the chest or shoulder does thicken, silicone gel sheeting worn over it is the treatment with the most evidence behind it, and the trials supporting it are small and of low quality. Start it once the wound is fully closed, and give it 8 to 12 weeks before judging it.Cochrane Database of Systematic Reviews O’Brien, 2013
An inflamed cyst is drained first and removed 6 to 8 weeks later, once the tissue has settled. Trying to take the sac out while it is inflamed leaves fragments and a worse scar.American Family Physician Zuber, 2002
Stop squeezing it. Every rupture scars the tissue around the sac, which makes a clean removal harder and the final line longer. If it has flared before, note how many times and roughly when, because that changes whether it comes out now or in 8 weeks.American Family Physician Zuber, 2002
If it is inflamed today, a warm compress for 10 minutes three times a day settles a proportion without anything else, and it costs nothing. If it is spreading, hot and painful, that needs to be seen the same day rather than waited out.
Do not buy a course of antibiotics for a lump that is not red, hot and spreading. An uninflamed cyst does not respond to them and taking them anyway is how resistance builds.NICE NG125, 2020
Do not pay for a removal on the day a cyst is inflamed if you can wait. Removing it at 6 to 8 weeks gives a better scar and a lower chance of it returning, and that is a delay that costs us the earlier booking.American Family Physician Zuber, 2002
Step 1
The doctor looks for the punctum, checks whether it is inflamed today, and asks how often it has flared.
Step 2
A quiet cyst comes out the same visit. An inflamed one is drained for relief and booked for removal once the tissue has settled.
Step 3
Removed intact under local anaesthetic so it does not refill. The tissue goes to a laboratory and the doctor gives you the result.
Ask before you book if you are not sure this is the right appointment.
Removal is £595. That fee covers the consultation, the anaesthetic, taking the sac out, the laboratory report and the follow up. Draining an inflamed cyst for relief is a different procedure at £495, and it does not stop the cyst refilling.
Because the lining is still there. Squeezing or draining a cyst empties the contents and leaves the sac, and the sac keeps producing. The only thing that stops it returning is removing the lining whole.
It can be drained, which relieves the pain. Taking the sac out while the tissue is inflamed leaves fragments behind and gives a worse scar, so removal is booked for 6 to 8 weeks later once things have settled.
No. Epidermoid cysts are benign. They are removed because they catch, show, smell when they discharge, or keep flaring. Everything taken out here is still sent to a laboratory so the diagnosis is confirmed rather than assumed.
A line a little longer than the cyst is wide, because a small ellipse of skin around the punctum has to come with it. On the chest, shoulders and upper back scars thicken more often, and the doctor will tell you if you are in that group.
Yes. Facial cysts are closed with finer stitches, taken out on day 7 rather than day 14, which is what keeps the line thin. The doctor marks where it will sit and shows you before starting, and will say if a plastic surgeon is the better hand for that particular spot.
The contents often do, which is keratin breaking down rather than infection. It is one of the reasons people choose to have them removed and it is not something to be embarrassed about in the room.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
American Family Physician, American Academy of Family Physicians
Minimal excision technique for epidermoid (sebaceous) cystsZuber, 2002
Cochrane Database of Systematic Reviews
Silicone gel sheeting for preventing and treating hypertrophic and keloid scarsO’Brien, 2013
General Medical Council
Decision making and consentGMC guidance, 2020
NICE
NICE
Surgical site infections, prevention and treatmentNG125, 2020
Plastic and Reconstructive Surgery
International clinical recommendations on scar managementMustoe, 2002
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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