Cyst Removal

[Tmcag]

Sorry to bother you, but I a question about some scalp (apparently standard-issue epidermal) cysts.  I had two develop a few years ago.  One doesn't really bother me, it's pretty small and innocuous, but the other is in a rather prominent area where the hair is particularly thin (not related to the cysts), and it has gotten somewhat larger over the past year.  
The doctors at my HMO advised me that either I should get used to it, or go in for full surgical excision.  I attempted to pursue surgery, in spite of the scarring potential, I figured it wouldn't be any worse than the cyst, which is pretty noticable on its own.  The problem is, when I actually went in for the surgery, I was told that scarring on the scalp would be substantially worse than on elsewhere on the body, due to the toughness of the skin (which would require a different kind of stitches used on the scalp) and the presence of hair follicles.  I was a little perturbed by this (not least because I was not told anything like that when I had consulted with the surgeon until the day when the procedure was supposed to have taken place,) and put off the procedure.

Sorry about the exposition, but it leads up to several questions I had about this.  Firstly, will the scarring on the scalp be substantially worse than elsewhere on the body if I have the procedure done?  Secondly, are there any treatment options for removal other than full surgical excision?  I've read of a few other treatments in what seemed to be credible sources, involving such processes as minimal excision technique, which might reduce the scarring due to stitches.  I scheduled a later appointment with the same surgeon to ask him about these;  he said he didn't know anything about it, and said I had likely misinterpreted something on draining cysts (I went back to the article, and I'm certainly not a doctor, but it seems to be a distinct procedure from drainage.)  Anyhow, after talking to the surgeon, they referred me back to a regular dermatologist to discuss these options.  Given the options I was given the first time around, I'm not terribly optimistic. I'd just like to note I was not demanding any particular procedure when dealing with the HMO physicians; my primary goal, which I told them, was to be able to make an informed decision, whether or not it the procedure was covered.  Finally, if it's not covered, and if it can't be answered on this site, that's fine, what is the general price range for the procedures?

This whole thing has been extremely frustrating for me.  Sorry, I'm normally not skeptical of doctors, but I really do feel like I've been getting the runaround on this from my HMO.  I would deeply appreciate some independent opinion on the risks and options on my case, thanks.  I know its not exactly a huge issue, but it really has bothered me for awhile.  Thanks.

[pookah99]

A related discussion, Post cyst surgery was started.

[miky1999]

A related discussion, mutiple cyst was started.

[JenniBug]

I had a cyst removed a few years ago, and within a few months it was back.  I advised the Dr about it, and he told me that it sometimes happens; not all was removed.  I asked if there was something I could do alone, instead of another Dr visit.  He advised that I could 'steam' it with the hottest water I could stand (but only on that area, as to avoid scalding the rest of my facial skin; the cyst was to the right of my mouth toward my cheek).  Then '*****' it with a clean needle, and try to get it out on my own.  
After a few weeks of this, it finally had a very small 'head' on it, and I was able to remove it myself.  (a very gross thing to see on yourself, and to do)  I have a very tiny scar where it was, but it has not come back since.
I have heard positive and negative things about what I had done, but the end result was ok.  Was there a possible risk??

[Tmcag]

Thanks a ton for your help;  definitely gave me a lot more information to work with.

[Alan Rockoff, MD]

I'm not much of a surgeon, but I remove scalp cysts pretty often and they seem to heal fine, with little noticeable scarring.  The technique I use (annd this may be the "minimal" one you read about, is to make a small incision, squeeze the cysts contents out to decompress it, and then pull the cyst wall out through the small hole.  Surgeons tend to make longer incisions, which would explain their comment about the extensiveness of the scar.

Anyhow, your dermatologist may well be able to expand on or do this.  I can certainly understand why you'd want a prominent protrusion removed from your head.  I think you'll be able to get satisfactory results, and in my experience, when it comes to things that grow on the face and scalp, insurance usually covers.  If it doesn't, I'd guess the fee to be in the $2-300 range, though this is of course just a guesstimate.

Good luck.

Dr. Rockoff