John is a 23-year-old male that has come to the office for a bump that has been on his back for 10 years and has not changed. Every so often he is able to squeeze out a smelly cheesy material but it always comes back to the same size. It gets a little tender when he carries his golf bag on his back after 18 holes, so he wants to know what his options are to remove it.
On the physical exam, I see a 2cm dome shaped smooth soft bump with a small dark pore in the center on his upper back. There is no redness or warmth of the area and the patient does not feel any pain when it is palpated. This is the typical history and physical description of an epidermal inclusion cyst.
I am sure you have heard of a cyst before but, what is the real definition of a cyst? A true cyst is an encapsulated lesion that contains fluid or semi-solid material in it. Although the skin is one of the most common places a cyst can form, they can be found anywhere in or on the body; the kidneys, breasts, knees and ovaries to name a few. Think of it as water balloon with the balloon being the capsule. The type of cyst will depend on the location and structure that it is found on and how it is formed. On a side note, acne “cysts” are actually pseudocysts because they do not have a capsule but localized blocked pores. Luckily the majority of cysts are benign or harmless.
The most common cyst on the skin is an epidermal inclusion cyst. They occur in 20% of adults, more commonly in the 20 to 40-year age range. They are more common in males than females. They can range from a few millimeters to a few centimeters and found most commonly on the trunk, neck, back, scalp and face.
Although cysts are benign, they can become inflamed or infected so they are often numbed and drained in the office or injected with steroids to decrease inflammation. Draining the cysts of its contents or taking the water out of the balloon, will not permanently get rid of the cyst. Antibiotics are used if the cyst becomes infected. Cysts will rarely if ever go away on their own. Some patients choose to get the cysts removed which require an excision which is a procedure that removes the sac (or balloon) completely and closes the area with stitches. Whether a cyst will become inflamed is unpredictable. You roll the dice.
Our patient John decided he wanted to make another appointment with me to have the cyst removed completely since it is bothering him when he plays golf. The cyst was subsequently removed without complications and maybe I can take a little credit for helping to lower his handicap this year.