I & Cyst

This afternoon I headed over to my dermatologist to have a pair of cysts removed from my scalp. And by removed I mean cut out of my head.

My predisposition to this charming condition seems to be slightly hereditary, as Famous Dad had some as well. Over the years, I've refered to them as my devil horns, which would startle whatever girlfriend I had that felt a small bump under my hair. They are not actually badges of my evil, but what are called pilar cysts, which are fairly common (about 5-10% of the population has them). Pilar aka trichilemmal cysts contain keratin and its breakdown products, lined by a wall resembling the external hair root sheath. Their origin is unknown, but it has been suggested that they are produced by budding from the external root sheath as a "genetically determined structural aberration". They arise preferentially in areas of dense hair follicle concentrations, and so most pilar cysts occur on the scalp.

How do they remove them? Here's the technical guide:

The skin overlying the site is cleansed with povidone-iodine solution. The skin overlying the cyst and the tissue to the sides and beneath the cyst are anesthetized with 2 percent lidocaine with epinephrine. A no. 11 blade is used to create a stab incision into the center of the cyst. A small-tipped hemostat is placed into the cyst, the tips gently opened and compression applied to allow the cyst contents to pass through the opening. The hemostat can be removed, and both thumbs are used to express the cyst contents. The hemostat can be reinserted, if needed, to assist with passage of the sebaceous material. Following vigorous and complete expression, the hemostat is reintroduced into the cyst cavity, and the capsule at the base of the wound is grasped and elevated. An attempt should be made to gently remove the entire sac through the small opening. The sac may break, and several pieces may need to be removed. At the end of the procedure, the wound should be inspected to ensure that all of the cyst wall has been removed.

A very fancy way of saying that once they've sterilized and numbed the area, they cut in, and force out the little baddie, before throwing some stitches in to close it up. These guys were a decent size (and bigger than the last time I had them extracted), and the doctor felt that it was best to shave a little of the area to get to them - bummer! It was a bloodier mess than before, but all I felt was warm blood and sweat drip down (I was under some pretty intense lights). To remove them, the doctor cut down almost to the bone to get them out, but he was able to take care of it without opening my head up too much. They also slapped bandages on and wanted me to come back the next day to see how it turned out.

Fortunately, everything went well and I'm not in pain. Last time I had the procedure done it was a shitty week after, but I got both an antibiotic to make sure there was no infection and Tylenol with Codine (level 3!) for the discomfort. I'm surprised it went better, because these little bastards were about twice the size of the other ones, approximately a centimeter and shaped like a cashew peanut. They're like little fattie, white globs, and I saw them suspended in a solution before they sent them to the lab to make sure there was nothing malignant about them. Meanwhile, I'm enjoying my few days I planned off work to rest and relax, and for those of you who need that kind of depth in storytelling, here's my stitched wounds, about an inch across: