Sebaceous Scalp Cyst What to Expect During and After Surgery

Aug 11, 2009

The Bottom Line Surgery was my treatment option for my sebaceous scalp cyst.

I've had a small lump on my scalp for at least the last 15 years. It never really bothered me. Sure it meant I had to part my hair on the right side instead of the left, but no one else, other than my husband and my hair dresser even knew it was there. Slowly over the years it grew from a small pea, to a large blueberry, to a small grape. I figured if I left it alone it would leave me alone. Until one day my little sebaceous cyst decided to act up and overnight it grew from a grape into a small walnut. Now I knew I couldn't ignore it any longer.

What is a Sebaceous Cyst
Sebaceous cysts can form anywhere there is a hair follicle but occur most often on the scalp, face, back and upper arms. The cysts can form due to a block sebaceous (oil) gland, a swollen hair follicle or even an injury. A sac forms under the skin and contains fluids (sebum or oil) and a paste-like core of dead cells, keratin (which is what hair is made of).

The First Doctor's Visits
My first visit was to my general practitioner. She took one look at the read, swollen cyst along my hairline and agreed with my layman diagnosis; the cyst was infected. She sent me off to pick up a prescription while she phoned a few colleagues to find a surgeon who could take a look at the cyst. She found one who could see me that afternoon. One look and he had a different diagnosis. The cysts was not infect, but had ruptured internally. The fluid that normally fills the sebaceous cyst was leaking out and irritating the surrounding tissue, which was causing the sudden growth, swelling and pain.

His treatment plan was to give the cyst material someplace to go, basically out through my scalp. He cleaned around the cyst and then used a punch biopsy tool to make a hole in my scalp. He then proceeded to squeeze out the fluid. This was a rather painful experience on already inflamed tissue. But I "was a trooper" according to my doctor and he was able to get out enough of the cyst to make me comfortable. He wrapped up my head and gave me plenty of instructions for the next few days.

I needed to shower at least 3 times a day, allowing the hottest water I could stand to flow onto the cyst, this would keep it open and draining. If I felt up to it, I could also squeeze as he had done to help remove the cyst contents. Otherwise I had to keep it under a sterile pad wrapped around my head with gauze. I was quite a sight leaving the doctor's office with my head bandaged; right out of a WW I hospital scene. I could feel every eye in the waiting room upon me as I headed for the car.

Two Days at Home
It took only about an hour for the pain of the cyst to subside. The swelling was down since the fluid now had an escape route; it was no longer pushing on the rest of my skin. I definitely felt much better. I took a shower that evening, and it was quite uncomfortable to have the water flowing into an open wound, but I manager to put up with it, re-wrap my head and go to bed. The next morning, after another hot shower, I was feeling a little braver. I stood at the mirror and squeezed on the cyst, It was a bit disturbing; there was some blood mixed with yellow fluid and at times small bit of solid matter flowed out and stuck to my hair. At times pushing would force just a little yellow fluid out and then pushing just a few millimeters over would force out a gush of fluids and solids. After a few minutes of this I was feeling a little woozy so I bandaged myself up and went about my day. I wore a handkerchief over my head in hopes of sparing some questions; instead I heard Yentl and Fiddler on the Roof jokes all day.

The Second Doctor's Visit
After two days of home treatment I returned to the surgeon on Friday afternoon. He took a quick look at the cyst, said it looked much better and scheduled me for surgery on Monday. I was disappointed that this wasn't something he could do in the office right then and there. I was more than ready to have this cyst out of my head. He assured me that the best way to handle this type of cyst was in a treatment room at the local hospital. He told me I could discontinue the home treatment and I could leave the cyst exposed and let a scab form. That wasn't so easy, since any time I touched that area or rolled over at night the wound would open up again, but it was nice to be able to keep the bandages off.

The Surgery
When I think of surgery, operating rooms and general anesthesia come to mind. The surgical removal of a sebaceous cyst is more of what I would call a procedure. I arrived at the hospital 30 minute before the procedure, registered and was taken into a room very similar to a high-tech exam room. I was given a gown to put over my shirt and was told I could remove my shoes if I though I would be more comfortable. The nurse took my vitals and in about 5 minutes the surgeon arrived ready to remove my cyst.

He started by cleaning the area and using a pen, he drew around the border of the cyst. Then he draped a sterile cloth around the cyst that also went over my face. This was the most difficult part of the procedure for me as I am slightly claustrophobic and I can't stand to have anything covering my face. However by the time the procedure was over, I decided I was glad to have been undercover for it.

The first step was to inject a local anesthetic into the area around the cyst. The large needles hurt penetrating the scalp and the anesthetic burns as it is injected. It took only a few seconds for it to start working and by the third or fourth needle prick I was only feeling pressure, no pain. Then the actual procedure began. There was no pain, but I was aware of what was going on. I could tell when he was using a scalpel to cut all around the cyst, there was a lot of tugging and pulling as he worked to remove the core of the cyst. Since the cyst had burst he also scrapped to remove anything remaining from the cyst so that it could not grow back and used an electric cauterization tool to burn any remaining cells. The smell was a little nauseating, but thanks to the drape over my nose I am sure I was spared the worst of it. After what was about 15 minutes he began to stitch up my scalp. The local was starting to wear off but I opted to deal with the pain of the stitches rather than the pain of another needle; it was my choice. There was a lot of tugging and pulling while he stitched. And then it was done.

It took the nurse much longer to clean me up than the actual procedure. The pillow behind my head was soaked in blood; I could feel the blood running into my ear and down my back, my hair was drenched. They made me sit for a few minutes while the nurse tried to clean up the worst of the mess. It was then that I got a good look at the cyst. As had been described in several internet articles, the solid part of the cyst did look like cottage cheese, still attached to a rather large flap of skin, which explained all of the pulling while stitching.

Eventually I was allowed to sit in the restroom while the nurse took washcloth after washcloth to try and make me presentable enough to leave. It took at least 30 minutes to get me to that point. It became apparent why this procedure is done in the hospital and not the office; I cannot recall ever seeing that much blood in one place. I left with my instructions to keep the stitches dry for the rest of the day but that I could shower the next morning but to put on bacitracin . Then I dove myself home.

At Home
I wish I could say that was the end of my cyst ordeal. I was sore as I drove to my mother's house to pick up my kids. By the time I sat there for a few minutes my head really started to hurt. I laid down at her house for almost 2 hours before I was ready for the 5 minute drive home. Then I crawled into bed with my kids to care for me until my husband came home some two hours later. I was in some serious pain by that point. I felt bad for my kids as I was only able to read to and tuck in my four year old son and I made my six and seven year old daughters put themselves to bed that night.

I was sent home with a prescription for pain, so I incorrectly assumed that this was not going to be a painful recovery. I was quite wrong. I had been given a pain prescription following real surgery in May and had only taken one. When I knew my husband was only 20 minutes from home I took a pill and waited it to kick in and put me to sleep. And I waited and waited and waited. On the pain scale, I was a solid 8, approaching 9 and it was not going down. While the pill made me nauseous, dizzy and sleepy (I don't know how House can function) I was still moaning in pain. Finally the time passed so I could take another pill at 2 AM and it finally dulled the pain enough so that I was able to get some sleep. I woke up around 6 AM and the pain was back. So long as I remained perfectly still it was bearable. I made breakfast for my son (who woke me up at 6) by having him bring me a yogurt carton to open for him and later a banana to peel. When my daughters woke up around 7:30 I had them call their grandmother to come and get them, because there was no way I was going to work or taking care of my kids that day.

My kids safely in the hands of a competent adult I took another pill and slept for 4 hours. When I awoke I finally felt at least a little better. The pain was still there but I could stand it. I felt well enough to take a shower and a couple of hours later I picked up my kids and even made them dinner. By then I was able to drop down to Advil to manage the pain. While the stitches were still uncomfortable, I could move my head without wanting to scream. I could dab on the bacitracin without sending lightening bolts through me head. Things were definitely looking up.

Back to Life
By Wednesday I was ready to get back to most of my life. I went back to work, still with some pain, but bearable with a strict schedule of Advil. There was still some discomfort because the skin on my forehead and scalp had been pulled tightly to close the hole left from the cyst. It took a week for the swelling to really go down, but everyday it looked a little better. Finally, after 10 days, the stitches were out and I felt normal again, minus my cyst.

While I can see the scar, so long as I do not choose to part my hair right over the scar, no one else is going to see it. I will no longer be embarrassed to swim and get my hair wet, something that always exposed my cyst. I am able to wear a headband without worrying that someone is going to notice the lump on my head. I do look forward to trying out some hairstyles that do not have to take into account their ability to hide my cyst.

Final Thoughts
If you have a sebaceous cyst and it bothers you consider having it removed before it starts to cause you any problems. Once the cyst ruptures, according to my surgeon, the removal is more difficult. If the cyst is in tact it can usually be removed that way so there is less irritation to the surrounding tissue. If the cyst is small enough it may be possible to remove it safely at home with the use of heat. Warm compresses can actually melt the solid matter in the cyst so it can be reabsorbed by the body; but this typically only works for cysts the size of a pea for smaller. For larger cysts, do not try to puncture them and remove them on your own; that is something for doctor to do.

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