Lipomas, Pilonidal Cysts, and Skin Lesions

There are a variety of skin conditions internal and external that can exacerbate to the point of requiring surgical intervention. The may cause discomfort such as benign tumors that can protrude from just below the skin to cysts and skin lesions that require either, drainage, removal or biopsy. The following are of the more common surgical conditions we treat.

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What are Lipomas?

Although Lipomas can occur at any age, they most often appear between the ages of 40 and 60 years. They are the most common soft tissue tumor found in adults and occur slightly more often in men than in women. It is possible to have more than one Lipoma.

Lipoma on backLipomas typically do not change after they form, and have very little potential for becoming cancerous. They often require no treatment other than observation. However, if a Lipoma is painful or continues to grow larger, it can be removed with a simple excision procedure.

There has been no proven connection between the development of Lipomas and any particular occupation or exposure to chemicals or radiation. Some doctors think that Lipomas occur more often in inactive people.

Biopsy. A biopsy is sometimes necessary to confirm the diagnosis of Lipoma. In a biopsy, a tissue sample of the tumor is taken and examined under a microscope. Your doctor may give you a local anesthetic to numb the area and take a sample using a needle. Biopsies can also be performed as a small operation.

In most cases of Lipoma, a biopsy is not necessary to confirm the diagnosis. After the Lipoma is removed, a biopsy will be done on a sample of the tissue.

Under a microscope, Lipomas often have a classic appearance with abundant mature fat cells. Sometimes there can be a small number of other cell types, too, such as cartilage or bone.

Lipoma Treatment

Excision (Removal)
The only treatment that will completely remove a Lipoma is a simple surgical procedure called excision.

Procedure. In this procedure, a local anesthetic is typically injected around the tumor to numb the area. Large Lipomas or those that are deep may require regional anesthesia or general anesthesia. Regional anesthesia numbs a large area by injecting numbing medicine into specific nerves. General anesthesia puts you to sleep. After the anesthesia is given, your doctor will make an incision in your skin and cut the tumor out.

Recovery. You should be able to go home soon after the procedure. You will have a few stitches, which your doctor will remove within a couple of weeks. How long it takes you to return to most daily activities will depend on the size and location of your Lipoma. If you have any pain or discomfort, you may want to limit some activity. Your doctor will provide you with specific instructions to guide your recovery.

Recurrence. Lipomas are almost always cured by simple excision. It is unusual for a Lipoma to grow back, but if it does recur, excision is again the best treatment option.

Pilonidal Cysts

How Can Pilonidal Cysts Be Treated?

There are a number of ways you can treat a pilonidal cyst. If you have only a simple, not inflamed, dimple or sinus tract you do not need any immediate treatment. The most common form of treatment to accurately get rid of these cysts is through a surgical procedure called incision and drainage.
Pilonidal cysts illustration

Incision and Drainage for Pilonidal Cysts

An inflamed pilonidal cyst is basically an abscess, therefore requires incision and drainage in order to improve. The procedure is fairly simple, but you must go through it. First of all, an anesthetic agent will be given to the area of affection. Afterward, the surgeon, with the use of a scalpel will incise the skin in order to expose the cyst and remove the pus, hair, and other skin debris inside the cystic formation. Once everything has been drained, the surgeon will either close the incision or just leave it unstitched and just covered with gauze.

Post-Surgical Care for Pilonidal Cysts

After the surgery, the patient may leave the clinic as soon as possible. No further admission to the hospital is needed since the procedure is, in fact, an outpatient procedure. The patient will have to take pain medications, anti-inflammatory drugs, and antibiotics to prevent discomforts during recovery. Wound care is also an important aspect during the post-surgical phase. Thus, it is important that the patient, as well as his or her caregiver, follows instructions on how to perform wound care effectively in order to prevent recurrence, infection and further complications.


Recovery Period for Pilonidal Cysts Surgery

Full recovery may take from several days to weeks depending on the form of surgery performed. For cases where the wound is closed after drainage, recovery would take a lot faster while for cases wherein the wound is left open and allowing the insides to heal first would take several weeks.

Skin Lesions

The surgical management of benign and malignant skin lesions may include:

  • Incisional biopsy including punch biopsy, shave biopsy
  • Excision biopsy with primary closure
  • Shave excision
  • Curettage
  • Electrosurgery including diathermy, coagulation, and cautery
  • Mohs micrographically controlled surgery
  • Complex reconstruction using flap procedure or skin graft

Combinations of these techniques are often used. The aim is for minimal scarring after any surgical procedure.

Mohs Surgery for Skin Lesions

Mohs surgery is a technique used in the treatment of several skin cancers that allows for complete removal of the lesion while minimizing removal of otherwise normal adjacent skin. Any location in the body can be treated with Mohs surgery, but it is typically reserved for nonmelanoma skin cancers occurring on the following locations:

  • Ears
  • Eyelids
  • Nose
  • Lips
  • Any sensitive location on the body that would have a higher risk of complications with regular surgical excision

Mohs surgery is a convenient and safe surgical technique that provides precise and complete removal of common nonmelanoma skin cancers while preserving as much normal skin surrounding the lesion as possible. Skin cancers removed typically include:

  • Primary basal cell carcinoma
  • Primary squamous cell carcinoma
  • Recurrent nonmelanoma skin cancers
  • Skin cancers with ill-defined borders
  • Skin cancers with high recurrence rates

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The doctors at Long Island Laparoscopic Doctors have either authored or reviewed and approved this content.

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