June 16, 2025 • 14 mins
⚕️ FREE MSRA PODCAST – Sebaceous Cysts
🎧 A clear, high-yield breakdown of these common benign skin lumps – ideal for clinical recognition and MSRA prep!
🧠 Key Learning Points
📌 Definition
• Sebaceous cysts (often epidermoid or pillar cysts) are non-cancerous, subdermal lumps
• Typically filled with keratin or sebum and found under the skin
📌 Causes & Risk Factors
• Blocked hair follicles or sebaceous glands
• Minor trauma, acne, hormonal changes
• Risk factors: oily skin, family history, acne
• 🧬 Gardner Syndrome: multiple early-onset cysts + bowel polyps + osteomas = RED FLAG
📌 Pathophysiology
• Blocked duct or follicle → buildup of keratin/sebum
• Forms a closed sac → enlarges over time
• Infection can occur → cyst becomes red, tender, swollen
📌 Symptoms
• Painless, mobile, dome-shaped lump
• Common sites: scalp, face, neck, back
• Central punctum often visible
• If ruptured: foul-smelling cheesy material
🧠 Mnemonic: PCP – Painless, Cheesy, Punctum
📌 Differential Diagnosis
• Lipoma: soft, deep, larger
• Neurofibroma: firm, multiple → consider NF1
• Abscess: red, hot, fluctuant
• Gardner’s syndrome: multiple facial/extremity cysts in young
📌 Diagnosis
• Clinical – based on appearance and history
• Ultrasound if deep or suspicious
• MRI for scalp cysts or if intracranial extension suspected
• Excision biopsy if atypical or growing fast
🚫 Fine needle aspiration NOT usually needed
📌 Management
• No treatment needed if asymptomatic
• If infected: incision & drainage + antibiotics
• Definitive treatment = surgical excision
→ Must remove entire cyst capsule to prevent recurrence
• Always send excised cysts for histology
🧠 Mnemonic: SEC – Symptomatic, Esthetic, Complicated
📌 Complications
• Infection → abscess
• Rupture → inflammation, recurrence
• Scarring post-excision
• Rare: intracranial extension (especially with scalp cysts)
📌 Prognosis
• Excellent with full excision
• Recurrence rare if capsule removed completely
• Malignant transformation is extremely rare
📎 More MSRA Resources for Sebaceous Cysts
📝 Revision Notes:
https://www.passthemsra.com/topic/sebaceous-cysts-revision-notes/
🧠 Flashcards:
https://www.passthemsra.com/topic/sebaceous-cysts-flashcards/
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/sebaceous-cysts-accordion-qa-notes/
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/sebaceous-cysts-rapid-quiz/
🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/sebaceous-cysts/
🎓 Full Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/
#MSRA #MSRA
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
OK, welcome back to the Deep Dive.
We've got some great source material sent in focusing on a
really key topic. If you're prepping for the MSRA
exam, sebaceous cysts. We're going to take what you've
given us and, you know, really boil it down to the essentials,
the high yield stuff you absolutely need.
Exactly. We're cutting straight to the
core here. We'll break down the crucial
(00:21):
details, especially on epidermoid and pillar cysts and
what they are, why they pop up, what they look like, and
crucially, how you'll manage them, all geared towards that
exam. Perfect.
So let's just dive right in. When we talk about these cysts,
sebaceous, epidermoid pillar lie, what exactly are we dealing
with? OK, so at the most basic level
(00:42):
they're described as non cancerous lumps.
They form just beneath the skin surface.
They're super common and thankfully almost always benign.
Nothing usually to worry about malignancy wise.
Right. And they have a certain look,
don't they? They do typically round, maybe
Dome shaped, and inside you might find this yellowish kind
of foul smelling cheesy materialthat's keratin buildup or sebum
(01:06):
and a really classic sign. You'll often see it right on the
skin over the lump is a little central opening.
We call that a punctum. OK, so a benign lump, possibly
smelly contents, and often that central dot.
Got it. You specifically mentioned
epidermoid and pillar cysts though.
Aren't they basically the same? Not quite the same origin, and
(01:27):
it's a useful difference to knowfor the exam.
Epidermoid cysts come from epidermoid cells, the skin
surface cells that somehow end up down in the dermis.
The deeper layer may be trapped there.
OK, whereas pillar cysts, sometimes called tracheomal
cysts, they actually arise from a specific part of the hair
follicle, the outer root sheath.OK, slightly different starting
point cell wise, but they end uplooking pretty similar under the
(01:50):
skin. Exactly that, Clinically they
can be hard to tell apart just by looking, and you'll hear the
term sebaceous cyst used broadly, but technically that
should mean from the sebaceous gland itself.
But really epidermoid and PLR are the common ones people mean
and they can appear almost anywhere.
Scalp, ears, back, face, neck, arms, trunk, even genital
(02:12):
regions. The sources even mentioned less
common spots like inside the mouth or eyes, palm soles, even
under fingernails. Wow, OK, quite the range.
Is there one place that's particularly important to
remember? Well, the scalp is definitely
one to flag. We'll circle back to why later,
potential deeper issues, but fornow, just remember they're
widespread. And a key point for management,
which we'll get to is removing the entire cyst wall, the whole
(02:35):
capsule. That's vital to stop it coming
back. Makes sense, Prevent recurrence.
So why do they even form? What causes them?
The ideology? The basic problem is usually
some kind of blockage or damage.So for what people loosely call
sebaceous cysts, maybe the duct of the sebaceous gland gets
blocked. For epidomort and pillar, it's
more about those skin cells or hair follicle parts getting
(02:58):
trapped or blocked off somehow. And are there things that make
that blockage or damage more likely?
Yeah, the sources list a few factors.
Things like minor skin trauma, acut or scrape, Hormonal changes
can play a role, maybe excessivesebum production, which kind of
makes sense. And genetics can be involved
sometimes too, though honestly often you don't pinpoint an
(03:20):
exact 'cause. Right.
So building on that, any specific risk factors or
conditions linked to them? Definitely a history of acne
seems to increase the risk. People with generally oily skin
might be more prone, and a family history of similar cystic
conditions is also mentioned. And there was that one specific
genetic condition highlighted inthe sources, Gardner syndrome.
Absolutely huge one for exams. Gardner syndrome.
(03:42):
It's an autosomal dominant condition.
And yeah, epidermoid cysts are abig feature, but it's way more
than just skin cysts. It includes familial ad,
anonymous polyposis, FAP of the colon.
That means hundreds, maybe thousands of polyps in the
bowel. Very high cancer risk there.
Plus you get other things like osteomas, these benign bone
growths, often skull or jaw and other soft tissue tumours.
(04:04):
Wow, so seeing lots of these cysts, particularly in certain
people, could be a signpost for serious internal stuff.
Precisely and the high yield bitthe cysts and gardeners often
show up early, think teenage years, and they tend to be on
the face and extremities, maybe more so than typical sporadic
cysts in older adults. So let's do a quick scenario.
Say 16 year old presents multiple small firm lumps,
(04:27):
cheese arms. What genetic condition jumps to
the top of your list? Gardner syndrome, definitely.
That link between the skin and the potential bowel issues is
critical. OK, let's switch gears a bit.
We know why they start, but how do they actually form the
pathophysiology? Think of it like a block drain.
Simple analogy, but it works. The opening, whether it's a
gland, duct or hair follicle gets blocked.
(04:47):
OK, so the stuff that you get out, sebum, keratin, it can't.
It gets trapped behind the blockage.
And that build up makes the lump.
Exactly. It forms a little pocket, a
closed sack or cyst right under the skin, and it just keeps
accumulating material. Over time it can get bigger, the
contents can get thicker, denser.
And that's where trouble can start.
Yeah, because that trap stuff isa nice environment for bacteria.
(05:09):
Sometimes it can get inflamed orinfected and that's when it
becomes red, painful, swollen, tender.
Got it. Blockage buildup forms the cyst.
Infection is a complication. Makes sense.
So if you see a lump under the skin, especially in an exam,
what else needs to be on your differential list?
What do you need to rule out? Key area this you need to know
(05:29):
what else it could be. Lipomas are probably #1 benign
fatty lumps, but they tend to feel softer than cysts, often
larger too. OK, softer is lipoma.
What else? Neurofibromas were mentioned,
they're from nerd sheath cells. They tend to feel harder, firmer
and sometimes like the cysts andgardeners, they can be multiple,
which might point towards neurofibromatosis, another
(05:51):
syndrome. But gardeners is the specific
link for epiduran cysts mentioned here.
And then there's the infected scenario.
If it's red hot, painful, is it an infected cyst?
Or is it a primary Abscess, justa collection of pus that formed
on its own? OK, so soft large thinkopoma,
hard multiple neurofibroma or consider a syndrome hot painful
(06:14):
infected cyst or primary Abscess.
And always keep gardeners in mind for those multiple facial
extremity cysts in younger people.
Clear. How common are we talking here
in the UKI say epidemiology. The sources don't give an exact
number, but they stress that epidermoid and pillar cysts are
very common. Really common.
They can happen at any age, but you see the most often in
adults, especially 20s and 30s. Any gender difference noted.
(06:36):
Yep, about twice as common in men compared to women.
And just as a side note, simple epidermoid cysts can sometimes
run in families even without gardeners.
OK, good to know. Let's talk clinical features,
patient walks in. What do you see?
What do you feel? Well the classic finding is a
painless lump. Unless it gets inflamed or
infected it usually doesn't hurt.
It feels pretty firm. Typically round or Dome like in
(06:59):
shape and often it's mobile. You can wiggle it slightly into
the skin. What about the skin over it?
Can look totally normal, or maybe slightly off colour,
whitish or yellowish. Size varies hugely.
Tiny little things up to severalcentimetres across.
And don't forget that punctum, that little central pore, seeing
that as a big clue. It's a cyst.
Right, the punctum. And if it ruptures or you
(07:20):
express it, you might get that characteristic cheesy, slightly
foul smelling material that's typical for epidermoid and
pillar types. Colour wise, usually skin
coloured yellowish white can look darker pigmented and people
with darker skin tones. And how does it all change if it
gets infected or inflamed? Oh, big difference.
Then it'll be ready. Vivitis, tender to touch,
(07:42):
painful, swollen. If it actually forms an Abscess,
it'll feel fluctuant, like there's fluid pus inside.
And remember, location matters too.
Cysts in tricky spots like the genitals or under a nail
subungle that can cause pain just from pressure or activity
even without infection. A subungle one might even change
the nail shape. Pomo plantar ones are also noted
(08:04):
as a specific group. OK, maybe a quick memory tip
here for the common cyst features.
Think PCP painless, less infected, cheese like contents
pumped them simple but might stick.
Let's try a quick exam so I'll check 40 year old women.
Small painless mobile lump on her neck.
You examine it, notice a tiny dark spot right in the middle.
(08:25):
Most likely diagnosis. Even it's painless, mobile and
has that punctum. Yeah, sebaceous cyst, probably
epidermoid is right up there. OK, my turn.
Patient has a lump on their back.
Had it for years, never botheredthem.
Suddenly over the last day or two, it's become really red hot,
throbbing pain. What's likely happened?
Sounds like that long standing, quiet cyst has got infected.
Good. So we've seen the patient
examine the lump. We think it's a cyst.
(08:46):
Do we need special tests? Investigations.
Right. This is really key exam
territory. The sources are clear.
Diagnosis is typically clinical.Often you can be pretty
confident just from the history and what you feel and see.
So when would you investigate further?
Well, sometimes imaging like ultrasounds, maybe MRI might be
useful. Perhaps if it's really large or
(09:08):
at a funny place near important structures, or if you're worried
about how deep it goes, like those scalp cysts we mentioned,
possibly connecting deeper and biopsy that's really reserved
for when you suspect malignancy.If it looks weird, growing fast,
ulcerated, then you plan an excision biopsy, take it out and
send it to the lab. But the sources explicitly say
things like fine needle aspiration or biopsy just to
(09:29):
diagnose a typical cyst rarely needed.
So the big takeaway on investigations?
Clinical diagnosis first and foremost.
Tests only if it's atypical, suspicious, or in a tricky spot.
OK. Clinical diagnosis, It is
usually. So let's say it is a typical
benign cyst. How do you manage it?
What's the plan? The first principle strongly
(09:50):
stated is that these often don'tneed any treatment at all.
If it's small, not bothering thepatient, not causing cosmetic
issues, just leaving it alone, watchful waiting is perfectly
fine. But what if it is bothering them
or causing problems? Then if treatment is needed,
maybe it's painful, getting infected repeatedly interfering
with life, or the patient just hates the look of it.
(10:12):
The main approach is surgical excision, removing it.
And you mentioned before about getting the whole thing out.
Absolutely vital the sources hammer this home.
To stop it coming back, you mustremove the entire cyst,
including its capsule, the wall around it.
Leave a bit of wall behind and it'll likely just fill up again.
What about if it's acutely inflamed or infected right now?
(10:33):
Yeah, that changes the immediateplan.
If it's red, raw and angry, especially if there's an
Abscess, you often deal with theinfection first.
That might mean incision and drainage, letting the pus out,
plus antibiotics. Then you probably plan to excise
the cyst properly later once theinflammation has calmed down.
Spontaneous resolution can happen apparently, but it's seen
(10:53):
as less definitive. Excision is the gold standard if
removal is indicated, and specifically for epidermoid
pillar cysts. Antibiotics if infected.
You can express the contents if it ruptures.
Interestingly, if it's inflamed but not infected, sometimes a
steroid injection can calm it down, though you'd still need
excision later for removal. Can you briefly outline the
(11:13):
steps for excision? Sure.
Standard minor OPS procedure, really informed consent first,
then local anaesthetic to numb the area.
Make an incision, usually elliptical, over the cyst,
carefully dissected out, making sure you get that whole capsule.
Then close the skin. And the really crucial step
afterwards, anything you excise should always be sent for
Histology. Yeah, always.
Even if it looks totally benign.Standard practise.
(11:35):
OK, So quick summary for management triggers think SEC
symptomatic, cosmetic concern orcomplicated like infection.
If yes, treatments probably needed.
Definitive is usually excision, get the whole capsule send for
Histology. Got it.
What's the general outlook then?Prognosis.
Generally it's excellent, reallygood prognosis.
(11:57):
Why so good? Because surgical removal done
properly is curative in most cases.
If you get that entire cyst and capsule out, recurrence is
pretty rare. Complications like infection or
scarring can happen, sure, but good management minimises those
risks, right? And Speaking of complications,
although the outlook's good, what potential problems can
arise? Well, infection is the big one.
We've mentioned pain, redness, swelling, maybe leading to an
(12:20):
Abscess, needing drainage, antibiotics.
Even without infection, it can just be a persistent lump that
causes discomfort or gets in theway.
And after surgery or messing with it?
You can get scarring, obviously,or other skin changes at the
site, and the sources specifically mention anxiety and
cosmetic concerns too, especially for facial cysts or
very visible ones. That distress is real for
(12:41):
patients. And the elephant in the room for
any lump Cancer risk. Malignant transformation.
OK, the sources are very reassuring here.
Malignant change in a standard sebaceous epidermoid or pillar
cyst is very rare, extremely uncommon.
It's not something high on the worry list for a typical
presentation, however. Remember that high yield point
(13:03):
about cysts on the skull? Yes, the potential deeper
connection. Exactly.
The sources highlight that thesecan rarely have connections
deeper down into the skull bone intrasius, or even potentially
towards the brain intracranial. It's unusual, but it means if
you see a scalp cyst that seems fixed or just feels odd, you
might need imaging like an MRI before attempting removal.
(13:24):
It needs careful handling awareness of that possibility.
That's a really crucial detail to file away.
Location matters. A scalp cyst isn't always just
skin deep. OK.
I think we've covered the journey pretty thoroughly there.
Definition, causes, risks like gardeners, how they form
differentials, features, diagnosis, management, prognosis
in those complications, including that important scalp
point, all with the MSRA in mind.
(13:46):
Yeah, absolutely. And thinking about that, that
point about malignancy being rare, yet we always send for
Histology. Why do you think that is?
Why is it still standard practise according to
guidelines? That's worth pondering.
Or going back to the skull cyst,what specific finding on
examination might make you more suspicious and lean towards
imaging compared to just a simple mobile scalp lump?
(14:08):
Good things to think about. Excellent points for reflection.
That wraps up our deep dive on sebaceous cysts, epidermoid and
pillar types, hitting the key takeaways from the sources for
your MSRA revision. Keep going through those
clinical scenarios, linking the features to the management.
You're building that knowledge base.
Good work. For more free MSRA revision
resources, definitely visit freenessara.com and for the full
(14:29):
Premium Revision Toolkit, head over to pass them sra.com.
OK, welcome back to the Deep Dive.
We've got some great source material sent in focusing on a
really key topic. If you're prepping for the MSRA
exam, sebaceous cysts. We're going to take what you've
given us and, you know, really boil it down to the essentials,
the high yield stuff you absolutely need.
Exactly. We're cutting straight to the
core here. We'll break down the crucial
(00:21):
details, especially on epidermoid and pillar cysts and
what they are, why they pop up, what they look like, and
crucially, how you'll manage them, all geared towards that
exam. Perfect.
So let's just dive right in. When we talk about these cysts,
sebaceous, epidermoid pillar lie, what exactly are we dealing
with? OK, so at the most basic level
(00:42):
they're described as non cancerous lumps.
They form just beneath the skin surface.
They're super common and thankfully almost always benign.
Nothing usually to worry about malignancy wise.
Right. And they have a certain look,
don't they? They do typically round, maybe
Dome shaped, and inside you might find this yellowish kind
of foul smelling cheesy materialthat's keratin buildup or sebum
(01:06):
and a really classic sign. You'll often see it right on the
skin over the lump is a little central opening.
We call that a punctum. OK, so a benign lump, possibly
smelly contents, and often that central dot.
Got it. You specifically mentioned
epidermoid and pillar cysts though.
Aren't they basically the same? Not quite the same origin, and
(01:27):
it's a useful difference to knowfor the exam.
Epidermoid cysts come from epidermoid cells, the skin
surface cells that somehow end up down in the dermis.
The deeper layer may be trapped there.
OK, whereas pillar cysts, sometimes called tracheomal
cysts, they actually arise from a specific part of the hair
follicle, the outer root sheath.OK, slightly different starting
point cell wise, but they end uplooking pretty similar under the
(01:50):
skin. Exactly that, Clinically they
can be hard to tell apart just by looking, and you'll hear the
term sebaceous cyst used broadly, but technically that
should mean from the sebaceous gland itself.
But really epidermoid and PLR are the common ones people mean
and they can appear almost anywhere.
Scalp, ears, back, face, neck, arms, trunk, even genital
(02:12):
regions. The sources even mentioned less
common spots like inside the mouth or eyes, palm soles, even
under fingernails. Wow, OK, quite the range.
Is there one place that's particularly important to
remember? Well, the scalp is definitely
one to flag. We'll circle back to why later,
potential deeper issues, but fornow, just remember they're
widespread. And a key point for management,
which we'll get to is removing the entire cyst wall, the whole
(02:35):
capsule. That's vital to stop it coming
back. Makes sense, Prevent recurrence.
So why do they even form? What causes them?
The ideology? The basic problem is usually
some kind of blockage or damage.So for what people loosely call
sebaceous cysts, maybe the duct of the sebaceous gland gets
blocked. For epidomort and pillar, it's
more about those skin cells or hair follicle parts getting
(02:58):
trapped or blocked off somehow. And are there things that make
that blockage or damage more likely?
Yeah, the sources list a few factors.
Things like minor skin trauma, acut or scrape, Hormonal changes
can play a role, maybe excessivesebum production, which kind of
makes sense. And genetics can be involved
sometimes too, though honestly often you don't pinpoint an
(03:20):
exact 'cause. Right.
So building on that, any specific risk factors or
conditions linked to them? Definitely a history of acne
seems to increase the risk. People with generally oily skin
might be more prone, and a family history of similar cystic
conditions is also mentioned. And there was that one specific
genetic condition highlighted inthe sources, Gardner syndrome.
Absolutely huge one for exams. Gardner syndrome.
(03:42):
It's an autosomal dominant condition.
And yeah, epidermoid cysts are abig feature, but it's way more
than just skin cysts. It includes familial ad,
anonymous polyposis, FAP of the colon.
That means hundreds, maybe thousands of polyps in the
bowel. Very high cancer risk there.
Plus you get other things like osteomas, these benign bone
growths, often skull or jaw and other soft tissue tumours.
(04:04):
Wow, so seeing lots of these cysts, particularly in certain
people, could be a signpost for serious internal stuff.
Precisely and the high yield bitthe cysts and gardeners often
show up early, think teenage years, and they tend to be on
the face and extremities, maybe more so than typical sporadic
cysts in older adults. So let's do a quick scenario.
Say 16 year old presents multiple small firm lumps,
(04:27):
cheese arms. What genetic condition jumps to
the top of your list? Gardner syndrome, definitely.
That link between the skin and the potential bowel issues is
critical. OK, let's switch gears a bit.
We know why they start, but how do they actually form the
pathophysiology? Think of it like a block drain.
Simple analogy, but it works. The opening, whether it's a
gland, duct or hair follicle gets blocked.
(04:47):
OK, so the stuff that you get out, sebum, keratin, it can't.
It gets trapped behind the blockage.
And that build up makes the lump.
Exactly. It forms a little pocket, a
closed sack or cyst right under the skin, and it just keeps
accumulating material. Over time it can get bigger, the
contents can get thicker, denser.
And that's where trouble can start.
Yeah, because that trap stuff isa nice environment for bacteria.
(05:09):
Sometimes it can get inflamed orinfected and that's when it
becomes red, painful, swollen, tender.
Got it. Blockage buildup forms the cyst.
Infection is a complication. Makes sense.
So if you see a lump under the skin, especially in an exam,
what else needs to be on your differential list?
What do you need to rule out? Key area this you need to know
(05:29):
what else it could be. Lipomas are probably #1 benign
fatty lumps, but they tend to feel softer than cysts, often
larger too. OK, softer is lipoma.
What else? Neurofibromas were mentioned,
they're from nerd sheath cells. They tend to feel harder, firmer
and sometimes like the cysts andgardeners, they can be multiple,
which might point towards neurofibromatosis, another
(05:51):
syndrome. But gardeners is the specific
link for epiduran cysts mentioned here.
And then there's the infected scenario.
If it's red hot, painful, is it an infected cyst?
Or is it a primary Abscess, justa collection of pus that formed
on its own? OK, so soft large thinkopoma,
hard multiple neurofibroma or consider a syndrome hot painful
(06:14):
infected cyst or primary Abscess.
And always keep gardeners in mind for those multiple facial
extremity cysts in younger people.
Clear. How common are we talking here
in the UKI say epidemiology. The sources don't give an exact
number, but they stress that epidermoid and pillar cysts are
very common. Really common.
They can happen at any age, but you see the most often in
adults, especially 20s and 30s. Any gender difference noted.
(06:36):
Yep, about twice as common in men compared to women.
And just as a side note, simple epidermoid cysts can sometimes
run in families even without gardeners.
OK, good to know. Let's talk clinical features,
patient walks in. What do you see?
What do you feel? Well the classic finding is a
painless lump. Unless it gets inflamed or
infected it usually doesn't hurt.
It feels pretty firm. Typically round or Dome like in
(06:59):
shape and often it's mobile. You can wiggle it slightly into
the skin. What about the skin over it?
Can look totally normal, or maybe slightly off colour,
whitish or yellowish. Size varies hugely.
Tiny little things up to severalcentimetres across.
And don't forget that punctum, that little central pore, seeing
that as a big clue. It's a cyst.
Right, the punctum. And if it ruptures or you
(07:20):
express it, you might get that characteristic cheesy, slightly
foul smelling material that's typical for epidermoid and
pillar types. Colour wise, usually skin
coloured yellowish white can look darker pigmented and people
with darker skin tones. And how does it all change if it
gets infected or inflamed? Oh, big difference.
Then it'll be ready. Vivitis, tender to touch,
(07:42):
painful, swollen. If it actually forms an Abscess,
it'll feel fluctuant, like there's fluid pus inside.
And remember, location matters too.
Cysts in tricky spots like the genitals or under a nail
subungle that can cause pain just from pressure or activity
even without infection. A subungle one might even change
the nail shape. Pomo plantar ones are also noted
(08:04):
as a specific group. OK, maybe a quick memory tip
here for the common cyst features.
Think PCP painless, less infected, cheese like contents
pumped them simple but might stick.
Let's try a quick exam so I'll check 40 year old women.
Small painless mobile lump on her neck.
You examine it, notice a tiny dark spot right in the middle.
(08:25):
Most likely diagnosis. Even it's painless, mobile and
has that punctum. Yeah, sebaceous cyst, probably
epidermoid is right up there. OK, my turn.
Patient has a lump on their back.
Had it for years, never botheredthem.
Suddenly over the last day or two, it's become really red hot,
throbbing pain. What's likely happened?
Sounds like that long standing, quiet cyst has got infected.
Good. So we've seen the patient
examine the lump. We think it's a cyst.
(08:46):
Do we need special tests? Investigations.
Right. This is really key exam
territory. The sources are clear.
Diagnosis is typically clinical.Often you can be pretty
confident just from the history and what you feel and see.
So when would you investigate further?
Well, sometimes imaging like ultrasounds, maybe MRI might be
useful. Perhaps if it's really large or
(09:08):
at a funny place near important structures, or if you're worried
about how deep it goes, like those scalp cysts we mentioned,
possibly connecting deeper and biopsy that's really reserved
for when you suspect malignancy.If it looks weird, growing fast,
ulcerated, then you plan an excision biopsy, take it out and
send it to the lab. But the sources explicitly say
things like fine needle aspiration or biopsy just to
(09:29):
diagnose a typical cyst rarely needed.
So the big takeaway on investigations?
Clinical diagnosis first and foremost.
Tests only if it's atypical, suspicious, or in a tricky spot.
OK. Clinical diagnosis, It is
usually. So let's say it is a typical
benign cyst. How do you manage it?
What's the plan? The first principle strongly
(09:50):
stated is that these often don'tneed any treatment at all.
If it's small, not bothering thepatient, not causing cosmetic
issues, just leaving it alone, watchful waiting is perfectly
fine. But what if it is bothering them
or causing problems? Then if treatment is needed,
maybe it's painful, getting infected repeatedly interfering
with life, or the patient just hates the look of it.
(10:12):
The main approach is surgical excision, removing it.
And you mentioned before about getting the whole thing out.
Absolutely vital the sources hammer this home.
To stop it coming back, you mustremove the entire cyst,
including its capsule, the wall around it.
Leave a bit of wall behind and it'll likely just fill up again.
What about if it's acutely inflamed or infected right now?
(10:33):
Yeah, that changes the immediateplan.
If it's red, raw and angry, especially if there's an
Abscess, you often deal with theinfection first.
That might mean incision and drainage, letting the pus out,
plus antibiotics. Then you probably plan to excise
the cyst properly later once theinflammation has calmed down.
Spontaneous resolution can happen apparently, but it's seen
(10:53):
as less definitive. Excision is the gold standard if
removal is indicated, and specifically for epidermoid
pillar cysts. Antibiotics if infected.
You can express the contents if it ruptures.
Interestingly, if it's inflamed but not infected, sometimes a
steroid injection can calm it down, though you'd still need
excision later for removal. Can you briefly outline the
(11:13):
steps for excision? Sure.
Standard minor OPS procedure, really informed consent first,
then local anaesthetic to numb the area.
Make an incision, usually elliptical, over the cyst,
carefully dissected out, making sure you get that whole capsule.
Then close the skin. And the really crucial step
afterwards, anything you excise should always be sent for
Histology. Yeah, always.
Even if it looks totally benign.Standard practise.
(11:35):
OK, So quick summary for management triggers think SEC
symptomatic, cosmetic concern orcomplicated like infection.
If yes, treatments probably needed.
Definitive is usually excision, get the whole capsule send for
Histology. Got it.
What's the general outlook then?Prognosis.
Generally it's excellent, reallygood prognosis.
(11:57):
Why so good? Because surgical removal done
properly is curative in most cases.
If you get that entire cyst and capsule out, recurrence is
pretty rare. Complications like infection or
scarring can happen, sure, but good management minimises those
risks, right? And Speaking of complications,
although the outlook's good, what potential problems can
arise? Well, infection is the big one.
We've mentioned pain, redness, swelling, maybe leading to an
(12:20):
Abscess, needing drainage, antibiotics.
Even without infection, it can just be a persistent lump that
causes discomfort or gets in theway.
And after surgery or messing with it?
You can get scarring, obviously,or other skin changes at the
site, and the sources specifically mention anxiety and
cosmetic concerns too, especially for facial cysts or
very visible ones. That distress is real for
(12:41):
patients. And the elephant in the room for
any lump Cancer risk. Malignant transformation.
OK, the sources are very reassuring here.
Malignant change in a standard sebaceous epidermoid or pillar
cyst is very rare, extremely uncommon.
It's not something high on the worry list for a typical
presentation, however. Remember that high yield point
(13:03):
about cysts on the skull? Yes, the potential deeper
connection. Exactly.
The sources highlight that thesecan rarely have connections
deeper down into the skull bone intrasius, or even potentially
towards the brain intracranial. It's unusual, but it means if
you see a scalp cyst that seems fixed or just feels odd, you
might need imaging like an MRI before attempting removal.
(13:24):
It needs careful handling awareness of that possibility.
That's a really crucial detail to file away.
Location matters. A scalp cyst isn't always just
skin deep. OK.
I think we've covered the journey pretty thoroughly there.
Definition, causes, risks like gardeners, how they form
differentials, features, diagnosis, management, prognosis
in those complications, including that important scalp
point, all with the MSRA in mind.
(13:46):
Yeah, absolutely. And thinking about that, that
point about malignancy being rare, yet we always send for
Histology. Why do you think that is?
Why is it still standard practise according to
guidelines? That's worth pondering.
Or going back to the skull cyst,what specific finding on
examination might make you more suspicious and lean towards
imaging compared to just a simple mobile scalp lump?
(14:08):
Good things to think about. Excellent points for reflection.
That wraps up our deep dive on sebaceous cysts, epidermoid and
pillar types, hitting the key takeaways from the sources for
your MSRA revision. Keep going through those
clinical scenarios, linking the features to the management.
You're building that knowledge base.
Good work. For more free MSRA revision
resources, definitely visit freenessara.com and for the full
(14:29):
Premium Revision Toolkit, head over to pass them sra.com.
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