Paul has had two sebaceous cysts removed in Thailand. One was from his neck and the other from an upper back area.
On April 15, 2021, I had a large sebaceous cyst removed from the left upper area of my back. My cyst measured 3.0x2.8x2.0 cm. It had been growing on my back for probably some months when my friend first suspected that it was a sebaceous cyst in June 2019.
In this article, I first define and describe a sebaceous cyst and where It can grow on the body. After explaining why it can appear, I relate the discovery and growth of a sebaceous cyst on my back. Finally, I note the medical diagnosis of my cyst and its removal by outpatient surgery with a local anesthetic in April 2021.
What Is a Sebaceous Cyst?
A sebaceous cyst is a common term used to refer to both an epidermoid cyst and a pilar cyst although neither of these contains sebum produced by the sebaceous gland.
The epidermoid and pilar cysts contain only keratin and do not originate in the sebaceous gland. Therefore, they are not real sebaceous cysts. A true sebaceous cyst is rare and known as a steatocystoma.
An epidermoid or epidermal inclusion cyst is a benign cyst found on the skin of body parts with little or no hair. Histologically, it is made of a thin layer of squamous epithelium and contains keratinous material. Approximately 85-95 percent of excised cysts are epidermoid and their malignancy rate is very low.
A pilar or trichilemmal cyst is a cyst that forms from a hair follicle usually on the scalp.
How Are Epidermal Inclusion Cysts Formed?
The surface of the skin (epidermis) is made up of a thin, protective layer of cells that the body continuously sheds. Most epidermal inclusion cysts or epidermoid cysts form when these cells move deeper into your skin and multiply rather than slough off.
Sometimes these cysts form due to irritation or injury of the skin or the most superficial portion of a hair follicle. Epidermal cells form the walls of the cyst and secrete a protein called keratin into the interior of the cyst. Keratin is a thick, yellow substance that sometimes drains from a cyst.
What Are The Symptoms of an Epidermal Inclusion Cyst?
The symptoms of an epidermal inclusion cyst include the following:
- a small, round bump under the skin, usually on the face, neck, or torso
- a tiny blackhead plugging the central opening of the cyst
- thick, yellow, smelly material that sometimes drains from the cyst
- redness, swelling, and tenderness in the area of the inflamed or infected cyst
The Symptoms of My Epidermal Inclusion Cysts
When I had a cyst on the left side of my neck in 2011, I noticed a tiny blackhead and redness in the area of the inflamed cyst.
The symptoms of my back cyst started to appear in 2019. My wife noticed a blackhead plugging the opening of the cyst. When she squeezed it, a thick, yellow, smelly substance came out.
By April 2019, the cyst had grown to a noticeable round bump on my left upper back.
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What Complications Can Arise?
The complications arising from an epidermal inclusion cyst may include:
- cancer (in rare cases)
Medical Diagnosis of My Sebaceous Cyst
I suspected of having a sebaceous cyst ever since my friend pointed it out to me in June 2019. It was small at that time and I never noticed a lump.
I did nothing about the cyst over the next two years because I couldn't feel or see it. In the early part of 2021, however, my wife often mentioned that the cyst on my back was getting bigger. Because I couldn't see the cyst and didn't feel it I wasn't concerned. When I finally saw the cyst in a mirror and felt it, I started to pay attention. After my wife showed me a picture of the cyst, I decided it had to be removed.
At the beginning of April 2021, I saw a surgeon at Bangkok Hospital in Udon Thani. Dr. Chatchai had done a good job fixing my inguinal hernia and also removing my wife's hemorrhoids. I trusted him in removing my sebaceous cyst.
When Dr. Chatchai examined my cyst on April 9, he immediately confirmed that it was a sebaceous cyst. On his computer, he showed me other cysts similar to mine. The doctor urged me to have the cyst removed immediately because it could be infected.
Preparation for My Cyst Removal
Dr. Chatchai scheduled my sebaceous cyst removal for the morning of April 15, 2021. The cyst would be removed in an outpatient setting at the hospital and I would be given a local anesthetic.
Before leaving the hospital, I was advised by the hospital that the surgery would cost about $300. Dr. Chatchai also prescribed an antibiotic and Paracetamol for any pain to be taken before the operation. A 1,000 mg tablet of Amoxicillin was to be taken twice a day after breakfast and dinner up to the date of surgery. I had no pain while taking the antibiotic.
Day of Surgery
On the morning of Thursday, April 15, 2021, at 9:45, I reported to Bangkok Hospital in Udon Thani for my cyst removal. Upon arrival, I had to answer questions about my previous medical operations, allergies to medicine, and whether I had been taking blood thinners like aspirin.
Next, I was sent to one of the treatment rooms in the emergency area of the hospital. Before lying down on a cot, I had to empty my pants pockets and remove my dentures. After removing my shirt, I was instructed to recline on my right side. A sheet was placed over my head so I could not see what was happening. Over my back was placed another sheet with a cutout to expose my cyst.
A few minutes later, Dr. Chatchai came into the room and my operation began. First, the doctor injected a local anesthetic into and around my cyst area. The anesthetic was Xylocaine (1%) with Adrenaline. The ingredient in Xylocaine was lidocaine hydrochloride. It is used to numb parts of the body for surgical operations and provides pain relief. Adrenaline is a vasoconstrictor. It makes the blood vessels where the injection is given narrower so there will be less bleeding.
After a few minutes when the Xylocaine started to work, Dr. Chatchai started to excise the cyst. During most of the surgery, Dr. Chatchai was chatting with his attending nurses. From the Thai that I could understand, they weren't talking about my cyst but rather about the doctor's Thai New Year visit to his relatives.
After about 45 minutes, the cyst was out and my wound closed with sutures. I could now sit upon the operating cot. Dr. Chatchai showed me the excised cyst which was now in formalin in a vial. It was big and would be sent to the Pathology Department for examination.
The doctor also showed me a picture of my wound area with sutures in it.
After getting up from the cot, I was told to sit in a wheelchair and stay there for at least 30-45 minutes. One of the side effects of Xylocaine is dizziness and impairment of mobility.
Later, after having my blood pressure checked, I was ready to leave the hospital. The doctor had prescribed more antibiotics and Paracetamol for me. With a water-proof bandage covering the gauze on my wound, a nurse advised me not to do any physical exercise until the wound was healed. The nurse also gave me an appointment slip to see Dr. Chatchai again on April 23.
Upon returning home, I only experienced pain after the anesthetic wore off about two hours after the operation. The pain was gone within 24 hours and I took antibiotic tablets twice a day for 3-4 days.
On April 23, I returned to the hospital. I was seen by a different surgeon since Dr. Chatchai was off that day. The doctor removed two of my sutures but left one in because the wound wasn't completely healed.
The doctor also showed me the pathology report. The diagnosis indicated that I had an epidermoid cyst with no definite evidence of malignancy seen. The cyst measured 3.0x2.8x2.0 cm and the thickness of the cystic wall was 0.1-0.c cm. Microscopic examination showed a cyst lined by benign-looking squamous epithelium, containing keratinous material.
On April 26, I returned to the hospital again and saw Dr. Chatchai. He removed the remaining suture and noted my wound was now healed. He also showed me a picture of where the cyst had been on my back.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2021 Paul Richard Kuehn
Paul Richard Kuehn (author) from Udorn City, Thailand on May 07, 2021:
I am pleased that you found this article interesting. I hope I don't get another one of these cysts. Two is enough!
RoadMonkey on May 07, 2021:
That was very interesting, thanks. A work colleague had to get one of these removed from the back of his neck a number of years ago and one of my sons had something similar done. It looks like the scar left after the operation would almost disappear in time. Nice fine line.
Paul Richard Kuehn (author) from Udorn City, Thailand on May 06, 2021:
Yes, Devika, I don't look forward to having another cyst. Thanks for commenting.
Paul Richard Kuehn (author) from Udorn City, Thailand on May 06, 2021:
Thanks for your concern, Pamela. Gratefully, very, very few cysts are malignant.
Devika Primić from Dubrovnik, Croatia on May 06, 2021:
PaulKuehn Thank you for sharing your experience about the cysts. Your experience doesn't sound good. Hope this doesn't happen again.
Pamela Oglesby from Sunny Florida on May 06, 2021:
You explained what happened and how the cyst was removed very well. It is great that it was not malignant. I hope you don't get any more cysts, Paul.