question and answer
Preventing keloid formation
August 2012
How do I remove a giant comedonal cyst (2x2 cm) from the interscapular area and leave minimal scarring in a keloid-forming patient?
R. Lewis, MD, Kamloops, BC

Any surgical procedure carries a risk of keloid formation in certain individuals. This is especially true when the surgery takes place on the shoulders and upper chest or back. In this circumstance, there’s a reasonable expectation that a keloid may form despite your best efforts.

While a keloid may be inevitable, certain steps can be taken to minimize this possibility. The epidermoid cyst can be removed by a keyhole technique. For example, the cyst can be entered through a 4 mm punch biopsy. The contents of the cyst can be expressed through the small hole. The lining of the cyst can be grasped by using forceps or using a curette. The cyst wall can then be extracted through the 4 mm punch hole. This can be sutured leaving a very small scar.

I’d recommend that the patient return for examination at 4 to 6 weeks post-surgery. If there is evidence of keloid formation, the keloid scar can be injected with intralesional steroid. In this way you can minimize the degree of scarring.

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