Laser Removal of Skin Cysts

They can be small, numerous bumps that appear on the skin of the face, or larger ones that usually appear on the rest of the body, especially on the back. They are formed by the “entrapment” of keratin, which is the protein that forms the skin and that we shed every day. For this reason, they are named “epidermoid cysts.”

Some very small ones can disappear spontaneously or through very discreet manipulation with needles. When they are deeper and larger, they displace neighboring tissues and can adhere to the skin segment where they originated, occasionally showing a small opening. Surgical resection is the norm. Some practitioners prefer to inject them with steroids, but complications such as atrophy and skin depigmentation, increased blood vessels, and persistence of the cyst can occur.

For smaller cysts, simple unroofing followed by complete extraction is usually sufficient. In larger lesions, the CO₂ laser facilitates subcutaneous dissection, while the initial skin incision is made with a scalpel to preserve the wound edges and allow optimal primary closure. Microscope-assisted dissection provides a cleaner, more precise operative field, enabling more accurate tumor removal.

The fundamental difference from conventional surgery lies in the dissection technique. Rather than performing blunt or sharp dissection through a field with continuous microbleeding, the CO₂ laser enables an almost bloodless dissection that progresses gradually from healthy tissue to healthy tissue. The excellent visualization of the surgical field allows precise identification of the tumor cleavage plane, minimizing trauma to the surrounding tissues and facilitating a more controlled and meticulous excision.

CO2 laser dissection of epidermoid cyst.

In these cases, the purulent material must be drained, and a gauze “wick” must be placed and changed daily until closure is ensured.

Closure by secondary intention can sometimes leave a better scar despite having to perform a greater number of healings.

They grow and sometimes are more numerous. They tend to be recurrent even after surgery.

They generally appear on the trunk of adolescents and young adults. They are characterized by having vellus hair shafts inside the cysts and are called eruptive vellus hair cysts. A solitary vellus-type cyst with terminal hair can occur, in most cases only on the head and neck.

They are especially located around the orbits, and their capsule contains skin appendages. The hair shafts are of the lanugo type. They are called dermoid cysts.

Epidermoid types form easily, conditioned by frequent scratching or rubbing. It is not uncommon to see hidrocystomas, which are transparent and ideal for intervention with laser given their thin capsule. Laser-assisted extraction of epidermoid cysts with laser.

Laser assisted emptying and vaporization of capsules.

Extraction of milium. No scars observed after 8 days.

Manual puncture of the capsule vs manual puncture + vaporization of the base using Er:YAG laser. Note the difference.