Introduction
Epidermoid cysts of the neck often cause significant concern for patients because they:
-
Are prone to inflammation
-
Occur in a highly visible area
-
Tend to leave noticeable scars after surgery
In this article, we present a case of an inflamed epidermoid cyst
on the neck that was surgically treated in 2016.
Eight years later, the patient returned to our clinic
for treatment of another cyst at a different site.
At that time, we were able to photograph the previously operated area.
Even as the surgeon who performed the procedure,
it was difficult to identify where the incision had been made,
as the area had healed remarkably well.
Case Presentation
The patient was a woman in her 40s.
As the epidermoid cyst on her neck became swollen and painful,
she searched online for a medical facility willing to perform surgery
despite significant inflammation and subsequently visited our clinic.
Fortunately, there was availability in the outpatient schedule on the day of her visit. After evaluation, we determined that same-day surgery was appropriate and proceeded with the operation.
The procedure was performed using the punch excision technique.
Surgical Procedure and Postoperative Management
Using punch excision,
the epidermoid cyst was removed completely along with its capsule.
Postoperatively, the wound was managed using
Natsui-style moist wound healing,
and no disinfection was performed at any point.
Showering and bathing were permitted from the day of surgery.
The postoperative course was uneventful.
As there were no signs of infection,
antibiotics were not prescribed.
Preoperative and Postoperative Course (2016)
For detailed information regarding the original surgical course in 2016, please refer to:
👉 “Severely Inflamed Epidermoid Cyst of the Neck (Punch Excision)”
(Published June 13, 2016)
Preoperative appearance of an inflamed epidermoid cyst on the neck with redness and swelling
Intraoperative view of capsule excision for an inflamed epidermoid cyst on the neck using punch excision
Immediate postoperative appearance after punch excision of a neck epidermoid cyst with minimal bleeding
Specimen showing complete capsule removal of a neck epidermoid cyst
Postoperative day 2 after punch excision of a neck epidermoid cyst, with minimal bleeding, swelling, and pain
Postoperative day 5 after punch excision of a neck epidermoid cyst, with no swelling, bleeding, or pain
Postoperative day 13 after punch excision of a neck epidermoid cyst, with the wound nearly healed and no symptoms
Postoperative day 79 after punch excision of a neck epidermoid cyst, with the scar barely visible
Despite surgery being performed during
a period of significant inflammation,
healing proceeded smoothly
without infection or complications.
Condition Eight Years After Surgery
Eight years after the original surgery,
the patient revisited our clinic for surgical treatment
of another epidermoid cyst at a different site.
At that time, we photographed the previously
operated area on the neck.
Eight years after punch excision of a neck epidermoid cyst, with no visible scar and no identifiable surgical site
As shown, it is impossible to determine
where the surgery had been performed.
Although the neck is an area with frequent skin movement
and is generally prone to scarring,
this case demonstrates that appropriate surgical technique
and postoperative wound care can result
in excellent long-term outcomes.
The Patient’s Words
At the follow-up visit, the patient shared the following comment:
“Thank you so much for treating me so beautifully.
You are truly my benefactor.
That’s why I came back immediately when I developed another cyst.”
As a physician,
receiving such words was deeply gratifying and encouraging.
Summary
The success of epidermoid cyst treatment
should not be judged solely by whether the cyst is
removed at the time of surgery.
What truly matters is the condition of the surgical site years later.
For patients with epidermoid cysts of the neck,
it is essential to carefully consider not only the surgical method
but also postoperative wound management when choosing treatment.
Frequently Asked Questions about Epidermoid Cysts (Atheromas)
Q1. What is an epidermoid cyst (atheroma)?
An epidermoid cyst is a benign tumor in which a sac-like capsule forms
beneath the skin and fills with keratinous material.
It does not resolve spontaneously,
and recurrence is likely if only the contents
are removed while the capsule remains.
Q2. Can surgery be performed even if the cyst is inflamed?
Yes. In some cases, surgery is possible even when inflammation is severe.
Inflammation does not necessarily mean that
treatment should be limited to antibiotics alone.
If the capsule can be appropriately removed,
recurrence can be prevented.
Q3. Can antibiotics cure an epidermoid cyst?
No. Antibiotics cannot cure the cyst itself.
They are used only when an infection is present and
do not eliminate the capsule.
Definitive treatment requires surgical removal of the capsule.
Q4. What is punch excision?
Punch excision is a surgical technique that removes the cyst capsule through a minimal skin incision.
By avoiding unnecessary cutting,
this method helps reduce tissue trauma and visible scarring.
Q5. Are scars more noticeable after surgery on the neck?
The neck is a highly mobile area and scars are generally more noticeable.
However, with appropriate surgical technique and postoperative care,
scars may become barely noticeable over time.
Q6. Is postoperative disinfection necessary?
At our clinic, postoperative care is managed using
Natsui-style moist wound healing.
Routine disinfection is not performed, as it can cause significant pain.
Instead, we focus on maintaining a moist wound environment.
Q7. Can I shower or bathe on the day of surgery?
In many cases, yes. Showering and bathing are often permitted
from the day of surgery.
Specific instructions may vary depending on the wound and location.
Q8. Do epidermoid cysts recur?
Recurrence occurs if the capsule remains.
When the capsule is completely removed, the risk of recurrence is very low.
Q9. How long does healing take?
Healing varies by individual, but generally:
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The wound stabilizes within weeks
-
The scar fades over several months
-
Over years, the scar may become unrecognizable
Q10. Is it safe to leave an epidermoid cyst untreated?
Leaving a cyst untreated may lead to sudden inflammation,
swelling, and pain.
Repeated inflammation can make surgery more difficult
and increase the risk of scarring.
Early consultation is recommended.
Q11. Can I seek consultation if another clinic advised observation?
Yes. Treatment approaches vary by institution.
Seeking another opinion is a reasonable option if questions remain.
Q12. How should I choose a clinic for cyst surgery?
Although epidermoid cysts may appear simple, long-term outcomes such as recurrence and scarring depend heavily on experience
and treatment philosophy.
Choose a clinic that clearly explains both surgical methods and postoperative care.
Our Treatment Philosophy: Natsui-Style Moist Wound Healing
Natsui-style moist wound healing
(The modern standard for scarless healing in Japan)
was established by Dr. Mutsumi Natsui,
a Japanese plastic surgeon widely recognized as a pioneer of moist wound care.
This method avoids the use of disinfectants and gauze, instead maintaining a moist wound environment to minimize pain and promote healing.
Our clinic practices wound management based on Dr. Natsui’s principles.
👉 Official website: “New Wound Treatment” by Dr. Mutsumi Natsui
This article is intended to organize and share medical knowledge
related to epidermoid cysts and wound care in a manner that is
understandable to the general public.
Actual treatment decisions should be made on an individual basis,
taking into account the condition of the lesion,
the patient’s background,
and clinical findings at the time of examination.
At our clinic, the treatment methods described in this article are considered
only after a medical examination,
and their appropriateness is determined on a case-by-case basis.
If medical judgment is required regarding the content of this article,
we ask that patients visit the clinic during consultation
hours for proper evaluation.
All articles on this blog are written by the clinic director.
While we receive numerous inquiries from SEO agencies,
we remain committed to sharing accurate medical information
based solely on our own clinical experience.
Author Information
Author: Hirotaka Kohrita, MD
Director, Kohrita-Hiro Orthopedic & Plastic Surgery Clinic
Specialties:
Orthopedic Surgery, Plastic Surgery, Burn Care, Epidermoid Cyst Surgery
Experience:
Over 6,000 epidermoid cyst surgeries performed
(approximately 500 per year).
More than 1,000 clinical cases using punch excision
and Natsui-style moist wound healing are published on this blog.
All cases are personally examined, operated on, and followed by the clinic director.
