Sebaceous cyst:- Examination, diagnosis and treatment

1. Sebaceous Cyst

2. • Sebaceous glands
• Glands in the skin that secrete a lubricating
substance called sebum.
• Sebaceous glands either open into hair follicles or
discharge directly on to the skin surface.
• They are most numerous on the scalp, face, and
anus and are absent from the palms and soles of the
feet.
• Sebum production is partly controlled by androgen
hormones.

3. Sebaceous Cyst
• Cyst of the sebaceous gland due to blockage
of the duct of this gland.
• The gland becomes distended by its own
secretion(sebum).
• Sebum is thick paste like yellowish, white,
cheesy, pultaceous material.

4. Clinical features
• It is commonly seen in young adults, though no
age is exempt.
• It may occur anywhere in the body except palm
and sole, though it is commonly seen in the scalp,
face and scrotum.
• It may be single or multiple.

5. Clinical presentation
• Patients presents with complain of swelling.
• Almost always there is a black spot on the swelling, which is the obstructed
opening and is called punctum.
• This swellingis fixed to the skin but is quite movable over the deeper
structures.
• Sebum can be squeezed out from this cyst through the punctum.
• Sometimes punctum is not visible.

6. Examination
• It is smooth and of round shape whose margin yields to the palpating finger.
• Overlying skin cannot be pinched.
• Fluctuation test is always present.
• Transillumination test is always negative.
• Painless unless inflamed.

7. Management
• (A) Sebaceous cyst (1.5 to 2 cm).
• (B) Inject 1 mL of local anaesthetic over the top of the
cyst to form a wheal.
• (C) Incise with a No. 11 blade directly into the cyst.
• (D) Express the contents of the cyst.
• (E) Sebaceous material.
• (F) Grasp the sac with haemostats and tease it free with
gentle lateral pressure and a rocking motion.
• (G) Sebaceous material and appearance of wound after
removal. No closure is needed for a small incision.
• Surgical Removal(excision) only.

8. Complications
• Infection when the cyst becomes enlarged and painful.
• Rupture and sinus formation.
• Ulceration.
• Calcification.
• Carcinomatous changes.
• Sebaceous horn