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Cutaneous Cysts

(Epidermal Inclusion Cyst [Epidermoid Cyst]; Milia; Pilar Cyst; Trichilemmal Cyst; Wen)

By Denise M. Aaron, MD, Assistant Professor of Surgery, Dartmouth-Hitchcock Medical Center; Staff Physician, Veterans Administration Medical Center, White River Junction

Cutaneous cysts are common, slow-growing lumps. Epidermal inclusion cysts are the most common cutaneous cysts.

Epidermal inclusion cysts (epidermoid cysts), often incorrectly referred to as sebaceous cysts, are flesh-colored and range from ½ to 2 inches (about 1 to 5 centimeters) across. They often have an enlarged pore overlying them. They can appear anywhere but are most common on the back, head, and neck. They tend to be firm and easy to move within the skin. They contain a cheesy, foul-smelling substance composed of skin secretions. Epidermal cysts are not painful unless they burst under the skin and become inflamed or infected.

Milia are tiny, superficial epidermal inclusion cysts. They occur most often on the face and scalp.

Pilar cysts (trichilemmal cysts or wens) may appear identical to epidermal inclusion cysts. About 90% of pilar cysts occur on the scalp. The tendency to develop pilar cysts may be inherited.

Cutaneous cysts can be removed surgically after an anesthetic is injected to numb the area. The cyst wall must be removed completely or the cyst will grow back. Cysts that have burst under the skin need to be cut open to drain. Tiny cysts that are bothersome can be lanced and drained.

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