surgery · epidermoid cyst · sebaceous cyst · subcutaneous lesions · Gdańsk
An epidermoid cyst, often commonly called a sebaceous cyst, is a benign subcutaneous lesion most often filled with keratin material. It usually looks like a round, movable lump under the skin, sometimes with a visible punctum or opening on the surface. It may appear on the face, scalp, neck, back, chest, groin, buttock, scrotum, near the anus or in a scar. A calm cyst does not always require urgent treatment, but a painful, red, growing, draining or recurrent cyst should be assessed by a doctor.
Epidermoid cysts and cyst-like lesions are consulted — depending on their location — by Piotr Rak, MD, PhD, Iwona Chruścicka, MD, PhD, Sara Godyńska, MD, Kamil Smok, MD and Justyna Szul, MD.
The most important answer
An epidermoid cyst is usually a benign subcutaneous cyst, but not every lump under the skin is an epidermoid cyst. A lipoma, fibroma, enlarged lymph node, abscess, pilonidal cyst, inflammatory lesion, skin tumour or a lesion requiring histopathological examination may look similar. If the cyst bothers you, grows, recurs, hurts, ruptures, drains material, is located in an irritated area or raises diagnostic concern, it is worth seeing a doctor. The most effective treatment usually involves surgical removal of the entire cyst together with its capsule, and the removed material may be assessed histopathologically.
What is an epidermoid cyst?
An epidermoid cyst, often commonly called a sebaceous cyst, is a cyst of the skin. In practice, the patient feels it as a round, fairly well-demarcated lump under the skin. Sometimes a small darker spot can be seen on the surface, corresponding to the cyst opening. Inside, there is usually a thick, whitish or yellowish mass with an unpleasant smell.
An epidermoid cyst may be small and cause no problems for a long time. It may also gradually grow, be aesthetically bothersome, rub against clothing, rupture, become inflamed or recur after spontaneous drainage. In the inflammatory phase, it may be red, painful and swollen — then it may resemble an abscess.
Where do epidermoid cysts most often appear?
Epidermoid cysts may appear in many areas of the body. Location matters because a lesion on the back requires a different pathway than a lump near the anus, groin, scrotum or breast.
- face and area behind the ear — often an aesthetic problem, but requires careful qualification,
- scalp — the lump may interfere with combing, haircutting or wearing a hat,
- neck, back, chest — common locations of large epidermoid cysts and cystic lesions,
- armpit and groin — the lesion may rub, recur or imitate an enlarged lymph node,
- buttock and natal cleft — an epidermoid cyst must be differentiated from a pilonidal cyst and an abscess,
- anal area — requires proctological assessment because an abscess, fistula, thrombosed external haemorrhoid or other lesions may look similar,
- scrotum and intimate areas — requires discreet assessment and differentiation from cysts, sebaceous lesions and infections,
- breast or area under the breast — requires diagnostic caution, especially when the lesion grows, hurts or is atypical,
- scar or post-procedure area — may require differentiation from granulation tissue, abscess, keloid or recurrence of a lesion.
Symptoms of an epidermoid cyst
- a round or oval lump under the skin,
- a lesion movable in relation to deeper tissues,
- a visible punctum or opening on the skin surface,
- slow enlargement of the lesion,
- sometimes an unpleasant smell after rupture,
- pain, redness and swelling in inflammation,
- drainage of whitish, yellowish or purulent material,
- recurrence after spontaneous drainage or squeezing.
Seek medical help sooner if the cyst:
- is growing quickly,
- is painful, red, hot or swollen,
- drains pus, blood or foul-smelling material,
- is located near the anus, in the groin, on the scrotum, in the breast or on the face,
- is accompanied by fever, chills or feeling unwell,
- is hard, immobile, irregular or looks different from a typical epidermoid cyst,
- recurs after previous drainage, incision or squeezing,
- occurs in a person with diabetes, reduced immunity or immunosuppressive treatment.
Epidermoid cyst, lipoma or abscess — how do they differ?
Epidermoid cyst
It is usually connected with the skin and may have a visible opening. It often contains thick keratin material. It may rupture, drain material and become inflamed. Removing only the contents without the capsule increases the risk of recurrence.
Lipoma
A lipoma is usually soft, movable, located deeper and has no opening on the skin. It usually does not drain any material. However, it may resemble an epidermoid cyst, so when in doubt, consultation is needed, and sometimes ultrasound or excision with histopathological examination.
Abscess
An abscess is a painful collection of pus. It typically causes redness, warmth, swelling, throbbing and increasing pain. An infected or ruptured epidermoid cyst may become purulent and require more urgent intervention. In such cases, treatment may first involve incision and drainage, and only later planned removal of the remaining cyst, if necessary.
Pilonidal cyst
Lesions in the natal cleft near the coccyx may be confused with an epidermoid cyst, but they are often pilonidal cysts. If pain when sitting, redness, small openings in the natal cleft or recurrent drainage appears, surgical or proctological assessment is required.
Can an epidermoid cyst be squeezed?
It is not worth it. Squeezing may cause the cyst to rupture under the skin, inflammation, infection, a scar and recurrence. Even if part of the contents can be emptied, the cyst capsule usually remains and may fill with material again.
Self-puncturing, squeezing or “burning off” lesions at home is particularly risky around the face, groin, scrotum, anus, breast and postoperative wounds. Lesions in these areas should be consulted with a doctor.
When does an epidermoid cyst require removal?
Not every epidermoid cyst requires an immediate procedure. Small, calm, painless lesions can sometimes be observed. Removal is more often considered when the cyst:
- is growing,
- is aesthetically bothersome,
- rubs against clothing or underwear,
- is located in an irritated area, e.g. belt line, bra line, collar, groin, buttock,
- recurs after previous inflammation or rupture,
- hurts, becomes red or drains material,
- raises diagnostic doubts,
- the patient wants to remove it before inflammation develops.
What does removal of an epidermoid cyst involve?
The procedure is usually performed under local anaesthesia. The doctor incises the skin, removes the cyst with its capsule and then places sutures and a dressing if needed. The aim is to remove the entire lesion because leaving part of the capsule may promote recurrence.
If the cyst is actively inflamed, painful or purulent, the doctor may first treat the acute condition — for example, drain the abscess, apply dressings or prescribe an antibiotic if indicated. Planned removal of the entire cyst may be easier and safer after the inflammation has settled.
Is histopathology needed after removal of an epidermoid cyst?
Histopathological examination makes it possible to confirm what the removed lesion was. It is especially important when the appearance is not typical, the lesion grows, recurs, bleeds, looks unusual, is located in a difficult area or the doctor wants to rule out another diagnosis. At Wyspa Medycyny Przyjaznej, the page on surgical removal of skin lesions emphasizes removal of lesions with histopathological examination.
Epidermoid cyst near the anus — why is this a separate pathway?
A lump near the anus is not always an epidermoid cyst. In this area, it is necessary to differentiate, among others, a perianal abscess, fistula, thrombosed external haemorrhoid, haemorrhoids, cyst, skin lesion, perianal skin tag or another proctological disease. If a lump near the anus hurts, grows quickly, makes sitting difficult, drains pus or is accompanied by fever, the patient should see a proctologist.
In such cases, the patient should not be automatically referred for “epidermoid cyst removal”. A proctological diagnosis is needed first.
How to prepare for the consultation?
- note when the lump became visible or palpable,
- check whether it grows, hurts, becomes red, drains material or ruptures,
- tell the doctor whether similar lesions occurred before,
- inform the doctor about diabetes, reduced immunity, anticoagulant medication and allergies,
- do not squeeze, puncture or irritate the lesion before the visit,
- bring ultrasound results, histopathology reports or documentation from previous procedures if you have them,
- if the lesion is near the anus, mention pain, drainage, fever, bleeding and bowel movement problems.
Patient pathway: from a lump under the skin to proper treatment
This tab is not the procedure page itself. It helps the patient understand what an epidermoid cyst may be and when to choose a surgeon or a proctologist.
The patient feels a round lump, sometimes with a punctum on the skin, without pain or with periodic inflammation.
Face, scalp, back, groin, buttock, breast, scrotum, anal area or scar — location determines the pathway.
The doctor assesses whether it is an epidermoid cyst, lipoma, abscess, pilonidal cyst, proctological lesion or another lesion requiring diagnostics.
A calm epidermoid cyst can be removed electively. An infected or purulent one may first require treatment of the acute condition.
Doctors consulting epidermoid cysts and cyst-like lesions
general and oncological surgeon
Consults and removes skin and subcutaneous tissue lesions, including epidermoid cysts, lipomas and other lumps requiring surgical assessment.
Doctor’s profile →general and oncological surgeon
Consults lesions of the skin, subcutaneous tissue and breast, including lesions requiring diagnostics, removal and histopathological examination.
Doctor’s profile →proctologist, surgeon
Consults lesions and lumps in the anal area that a patient may confuse with an epidermoid cyst, abscess, thrombosis or another proctological disease.
Doctor’s profile →surgeon, proctology
Consults lesions in the anal area, buttock and natal cleft, including lesions confused with an epidermoid cyst, abscess or pilonidal cyst.
Doctor’s profile →proctologist, surgeon
Consults lumps, swellings and draining lesions in the anal area that require differentiation from an epidermoid cyst, abscess, fistula or thrombosis.
Doctor’s profile →Do you have a lump under the skin or suspect an epidermoid cyst?
Do not squeeze the lesion. Book a consultation — the doctor will assess whether it is an epidermoid cyst, lipoma, abscess, pilonidal cyst, proctological lesion or another lump requiring diagnostics.
FAQ – epidermoid cyst
Is an epidermoid cyst dangerous?
Most often, an epidermoid cyst is a benign lesion, but it requires assessment if it grows, hurts, becomes red, drains material, recurs or looks atypical. Not every lump under the skin is an epidermoid cyst.
Can an epidermoid cyst be squeezed?
It is not worth it. Squeezing may lead to inflammation, infection, rupture of the cyst under the skin, scarring and recurrence. Even after the contents are emptied, the capsule usually remains.
Can an epidermoid cyst turn into an abscess?
An infected or ruptured epidermoid cyst may cause symptoms similar to an abscess: pain, redness, swelling, pus discharge and fever. In such cases, more urgent medical assessment is needed.
What does removal of an epidermoid cyst involve?
Most often, the procedure is performed under local anaesthesia. The doctor removes the lesion together with the capsule, places sutures and applies a dressing. Removing the entire capsule reduces the risk of recurrence.
Does an epidermoid cyst need histopathological examination?
Histopathological examination makes it possible to confirm the diagnosis. It is particularly important if the lesion is atypical, grows, recurs, bleeds, hurts or the doctor wants to rule out another diagnosis.
Should a cyst near the anus be removed by a surgeon or a proctologist?
A lump near the anus should first be assessed by a proctologist because a perianal abscess, fistula, thrombosed external haemorrhoid, haemorrhoid, skin tag or another proctological disease may look similar.
Who consults epidermoid cysts at Wyspa Medycyny Przyjaznej?
Skin and subcutaneous tissue cysts are consulted by Piotr Rak, MD, PhD and Iwona Chruścicka, MD, PhD. Lesions in the anal and buttock area are consulted by Sara Godyńska, MD, Kamil Smok, MD and Justyna Szul, MD.
Related pages
This tab explains what an epidermoid cyst is. A detailed description of the procedure, prices and preparation should remain on the service pages to avoid cannibalization.
- Surgical removal of skin lesions with histopathological examination
- Removal of skin lesions
- Surgical skin biopsy
- Surgery
- Surgery price list
- Lump under the skin
- Abscess
- Pilonidal cyst
- Lump near the anus
- Proctological consultation
- Piotr Rak, MD, PhD
- Iwona Chruścicka, MD, PhD
- Sara Godyńska, MD
- Kamil Smok, MD
- Justyna Szul, MD
Book a consultation — not every lump is an epidermoid cyst
If you have a lump under the skin, a lesion in the groin, on the buttock, near the anus, in the breast or in a scar, book a consultation. The doctor will assess whether removal, histopathology, treatment of inflammation or diagnostics of another cause is needed.
The information on this page is educational and does not replace medical consultation. An epidermoid cyst may resemble other subcutaneous lesions, an abscess, pilonidal cyst, enlarged lymph node or a lesion requiring histopathological examination. Diagnosis, urgency of treatment, surgical removal, histopathological examination and management of inflammation are decided by the doctor after examination. Medical review is required before publication.