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PATIENT EVALUATION AND SELECTION
PATIENT EVALUATION AND SELECTION
Preoperative consultation is required to ensure adequate patient preparation and selection. This begins with a focused history, including prior excision, incision and drainage, or recurrent inflammation; this is helpful as there is increased risk of scar formation and recurrence as it may be more challenging to remove the cyst in its entirety.
Not all cysts are best served by immediate excision; inflamed cysts are better approached with intralesional corticosteroids or incision and drainage, as inflammation is an indication that the cyst wall has already ruptured. Inflammation causes local warmth, erythema, and pain from an acute foreign body reaction to the ruptured cyst contents. Occasionally, ruptured cysts become secondarily infected, requiring oral antibiotic therapy. In such cases, surgical excision should be delayed until frank infection has been cleared and the inflammation has markedly abated. A detailed conversation including the risks, benefits, and alternatives of surgery will not only permit the patient to better grasp the procedure, but may also help to mitigate the risk of adverse outcomes by encouraging improved compliance with postoperative instructions. Patients should always be advised regarding the risks of cyst excision, including the
potential for recurrence, infection, and scarring.