Cysts are common skin lumps that can appear in any part of the body. Most cysts are benign, and develop naturally or after injury to the skin.

The most common cyst is the epidermal cyst (also known as sebaceous cyst), but there are actually many different kinds of cysts and treatment can be different. Some conditions, including certain types of skin cancers, can also masquerade as cysts.

Here, we will look at the different types of skin cysts and their mimickers, what causes them, and the various methods available for their safe and effective removal. Armed with more information, you will be able to have a more meaningful consultation when you see your doctor to discuss the treatment options available.

For effective removal of cysts, our Gleneagles dermatologist and dermatologic surgeon can advise you on the most suitable methods to reduce scarring.

 

What are skin cysts?

 

Cysts are small sacs or pouches that form underneath the surface of the skin. Their exact etiology is unknown, but some cases have arisen after some minor trauma, where skin cells from the top layer of the skin (epidermis) are deposited into the deeper layers (dermis). It is believed that some of the trapped epidermal cells continue to grow and produce skin protein underneath the surface, resulting in the formation of cysts.

Typical cysts have a lining (cyst wall) that form the sac. Within the sacs are usually thick, sticky liquid material made up of skin proteins. Some cysts open to the surface of the skin with a small punctum that looks like a blackhead. When squeezed, the contents of the cysts can discharge from the opening, releasing a thick yellowish fluid that resembles pus and has a characteristic malodor which some describe as “cheesy”.

 

What are the different types of cysts?

 

1. Epidermoid cysts (Sebaceous cysts)

 

Epidermal cysts, also known as sebaceous cysts, are the most common type of cysts that grow on the skin. Epidermal cysts can range from a few millimetres to many centimetres in size, and can occur anywhere on the body. This type of cyst usually contains a thick, yellowish, malodorous substance with an appearance like spoilt cheese.

Epidermal cysts are benign, and small ones can be left alone. However, large cysts, especially those on the back, buttocks or legs, are prone to being compressed and becoming inflamed. These should be preferably removed before they cause any pain or inflammation.

 

Removal methods:

 

• Excision: In this method, the whole cyst is surgically removed, and the chance of it recurring is low. This is the preferred way of removal for the majority of patients. If the operation is done before the cyst becomes inflamed, it is possible to minimise the incision (cut) on the skin over the cyst, giving rise to a smaller, more aesthetically pleasing scar. Cyst surgery by our dermatologic surgeons is usually performed under local anaesthesia as a day surgery, which reduces the risks of complications, length of hospitalisation, and costs to our patients.
• Incision and drainage: In this method, an incision is made over the cyst and its contents expressed. This treatment is sometimes employed when the cyst is infected, and there is pus within the cyst. Unlike excision, the wound is not stitched up after surgery, but covered with a dressing to absorb any new pus that forms. It may take up to eight weeks for the wound to heal completely, during which regular dressing changes are required.

 

What treatment methods are not suitable:

 

• Manually squeezing out cyst contents: Some patients or doctors attempt to squeeze the contents from the cyst through the punctum. This is not recommended as the cyst contents will fill up again as long as the lining of the cyst is not removed. Manually squeezing the cyst may cause it to burst beneath the surface of the skin, giving rise to inflammation, pain, and swelling.
• Steroid injections: Steroid injections are used to treat acne cysts, which are not true cysts in the sense that these do not have a cyst wall lining. Acne cysts are actually collections of inflammation under the skin, and steroid injections help to reduce the inflammation. Steroid injections should not be used to treat epidermal cysts.

If you’re concerned about a cyst, or the cyst has become inflamed and is painful, a dermatologist can offer advice on the best sebaceous cyst removal in Singapore.

 

2. Pilar cysts (Trichilemmal cysts)

 

Pilar cysts, also known as trichilemmal cysts, are most commonly found on the scalp. Pilar cysts sometimes run in families as a genetic condition, and patients may have multiple cysts on the scalp. They appear very similar to epidermal cysts, but are slightly firmer to touch.

 

Removal methods:

• Removal options for pilar cysts are similar to those for epidermoid cysts, though excision is the preferred method to prevent recurrence.

 

3. Mucus cysts (Mucocele)

 

Mucus cysts, or mucoceles appear as small, dome-shaped, almost translucent bumps that are most commonly found on the lower lip (though they can also be found inside the mouth). They are usually caused by blockages in the salivary glands due to biting the lip or cheek. Mucus cysts can sometimes resolve by themselves. Those that recur repeatedly or are causing difficulty in eating or speech may require treatment.

 

Removal methods:

 

• Cryotherapy: In cryotherapy, a very cold agent (commonly liquid nitrogen) is used to freeze the cyst. This causes damage to the cyst, resulting in it drying up. Larger cysts may require multiple treatments.
• Laser ablation: Mucus cysts can also be destroyed using an ablative laser, such as the Smartxide Deka CO2 laser.
• Surgical excision: Large or deep mucus cysts, or those that recur despite other forms of treatment can be removed surgically. The skin on lips often heals well with little scarring.

 

4. Digital mucous cysts (Myxoid cysts)

 

Digital mucous cysts (also called myxoid cysts, digital myxoid pseudocysts, digital ganglion cysts, and digital synovial cysts) are shiny dome-shaped bumps that develop on the ends of fingers or toes, often near the nails. These cysts are filled with a jelly-like substance and are sometimes linked to osteoarthritis.

Digital mucous cysts are actually not “true” cysts (hence they are called “pseudocysts”) because they do not have a real cyst wall lining. While small, these cysts can cause discomfort and nail deformity if they press on the nearby nail.

 

 

Removal methods:

 

• Repeated pressing: Small digital mucous cysts may resolve if one repeatedly presses on it firmly.
• Squeezing out the contents: In this method, a small hole is created on the surface of the cyst using a sterile needle, and the contents squeezed out.
• Cryotherapy: Freezing the cyst with a cryogen (usually liquid nitrogen) damages the cyst and may cause it to go away.
• Steroid injection: Injection of a small amount of steroid into the cyst has also been shown to be effective sometimes to treat it. This can be combined with squeezing out the contents of the cyst first before the steroid is injected.
• Surgical excision: Persistent or troublesome digital mucous cysts may be removed by surgery.

 

5. Steatocystoma multiplex

 

Steatocystoma is a benign cyst that arises from the hair follicle. If there is only one or two steatocystomas, the condition is called steatocystoma simplex.

More commonly, patients present with multiple steatocystomas on the chest, abdomen and arms, in a condition called steatocystoma multiplex. This is an inherited condition that usually becomes obvious after puberty. Patients may notice one parent having the same condition, or they may be the first person in the family to have it due to sporadic genetic mutations.

Steatocystomas are harmless, but patients often desire removal due to aesthetic reasons.

 

Removal methods:

 

• Surgical excision: Cysts may be individually removed by surgery, but the number of cysts involved may result in many small scars.

 

Conditions that resemble cysts but are not

 

1. Lipomas

 

Lipomas are benign (non-cancerous) growths made up of adipose (fat) tissue. These are commonly found on the trunk or limbs, and can grow to a large size. Lipomas are usually soft to touch and move underneath the surface of the skin. They may be left alone, or removed by surgery.

Rarely, lipomas can turn cancerous liposarcomas. If a long standing lipoma starts to grow rapidly in size or becomes painful, it is advisable to get a skin specialist to have a look at it to exclude a liposarcoma.

 

2. Basal cell carcinomas

 

Basal cell carcinomas are the most common type of skin cancer in the world. They can appear as smooth, pearly bumps on the skin, and may be mistaken for cysts to the untrained eye. Basal cell carcinomas are often found on the face, but may also appear on the trunk and limbs.

 

What should you consider when deciding whether to have the cyst on your skin removed?

 

Before deciding on skin cyst removal surgery in Singapore, it’s important consider the following factors:

 

1. Is my lump really a cyst?

 

As mentioned earlier, some skin conditions may look like cysts but are actually not, and treatment may be different (including non-surgical options), or may not even be necessary. If in doubt, it is best to first consult a dermatologist who is familiar with the different types of skin growths

 

2. What type of cyst is my lump?

 

Most common cysts, such as epidermal (sebaceous) cysts, are removed by surgical excision, but some cysts or cyst-like lumps may be amenable to non-surgical options.

 

3. If surgery is required, what type of surgery is needed?

 

Epidermal cysts which are not infected or inflamed can often be removed with a smaller incision (cut) than the size of the actual lump. This form of minimal skin surgery decreases the risks of complications, such as bleeding and infection. It also reduces the length of the final scar so that it is more aesthetically pleasing.

 

4. Is my surgeon experienced in skin surgery and cyst removal?

 

Dermatologists perform the majority of skin surgeries throughout the world. Dermatologic surgeons are a subset of dermatologists who have undergone further advanced training (usually years) in skin surgery, and are well versed in the different techniques of skin surgery that can give rise to the best possible outcome. With their foundation in medical (non-surgical) dermatology, dermatologic surgeons can also advise on non-surgical options if these are preferred.

If you’re experiencing any discomfort, inflammation, or rapid growth of a cyst, seeking advice from a dermatologist can help you determine the most effective treatment plan.

 

Conclusion

 

Whether you’re dealing with an epidermal (sebaceous) cyst, pilar cyst, or even multiple small cysts from steatocystoma multiplex, it’s important to understand your options for safe removal. While some cysts can be left alone, others may require medical intervention to prevent complications or cosmetic concerns. At TSN Dermatology, we provide compassionate dermatology care, offering expert advice and treatment for all types of skin cysts. If you’re seeking effective skin cyst removal, we’re here to help you every step of the way.