Excision of Subcutaneous Nodules
Thomas J. Tachovsky, MD, FACS
or the surgeon involved in office or ambulatory sur-
F gery, patients concerned about "this lump" are prob-
ably exceeded in number only by patients worried about
an actinic or pigmented skin lesion. Evaluation and treat-
ment of these common subcutaneous lesions thus consti-
tute a significant portion of the surgeon's office or ambu-
latory practice. The great majority of these are dermal
inclusion (retention) cysts and relatively straight forward
lipomas. Most can be removed, if indicated, in the ambu-
latory setting with simple infiltration local anesthesia and
readily available equipment. Whether the lesion requires
removal depends on the patient's preference and the sur-
geon's judgment.
Cysts
Sebaceous cysts are usually easily identified by noting the
typical central "pore," actually the duct opening on the
From the Department of Surgery, St. Luke's Hospital Bethlehem, PA.
Address reprint requests to Thomas J. Tachovsky, MD, FACS, Department of
Surgery, St. Luke's Hospital, 801 Ostrum St., Bethlehem, PA 18015.
Copyright 2002, ElsevierScience(USA).All rights reserved.
1524-153X/02/0403-0001 $35.00/0
doi:10.1053/otgn.2002.35338
214 Operative Techniques in General Surgery, Vol 4, No 3 (September),2002: pp 214-222
skin overlying the dilated gland. This type of cyst devel-
ops when a duct of one of the sebaceous glands occludes
and the continuing secretions collect in the gland. Under-
standably, these cysts are most common in areas where
the supply of sebaceous glands is richest, such as the
scalp, the periauricular area, the face and neck, and the
torso. ~ They are much less common on the extremities.
The main associated risk is infection in the occluded
gland. This is easily recognized by the surrounding ery-
thema, edema, and local tenderness. In the acutely in-
fected state, a clean excision is not easily performed, and
thus incision and drainage may be the only immediate
surgical option. Avoiding this, less than desirable, situa-
tion is the main reason why elective surgical excision in
the noninfected state is preferable. In many cases, the cyst
presents a cosmetic problem, in other cases, the simple
presence of an undiagnosed, easily felt "lump" motivates
the patient to have it removed. These cysts occur at any
age and usually can be diagnosed by simple inspection.
Sometimes, however, they must be differentiated from
other types of skin and subcutaneous tumors, such as
neurofibromas, lipomas, and other, rarer tumors of the
skin and its appendages. Their size may vary from a few
millimeters to several centimeters.