Removal of an atheroma – in brief
| What is being removed | Sebaceous cyst (atheroma), along with the capsule |
|---|---|
| Methods | Surgical removal; radiofrequency removal for selected smaller lesions |
| Anaesthesia | Local |
| Duration of the procedure | For minor changes, usually 15 to 30 minutes |
| Why the capsule is important | Her complete removal reduces the possibility of the cyst recurring |
| Inflamed atheroma | First the inflammation is treated, and removal is planned according to the findings |
| Tissue analysis | The removed tissue is sent for histopathological analysis at the physician's discretion |
| Price | In the current dermatology price list |
What is an atheroma and what does it look like?
The term “atheroma” is often used for an epidermoid cyst — a thin-walled lesion, or capsule, containing predominantly keratin. In everyday speech, the term “sebaceous cyst” is also used, although this name is not always medically precise.
An atheroma usually appears as a rounded lump in or just beneath the skin, skin-coloured or slightly reddish, with a smooth and shiny surface. The size ranges from a few millimetres to several centimetres. A small opening or depression can sometimes be seen on the surface, and the lesion is most commonly soft and movable under the fingers. It most frequently occurs on the face, neck, behind the ears, on the back and chest, but can also develop on other parts of the body.
Pilar cysts also occur on the scalp, which have a different origin, and a similar lump can also be a lipoma or another lesion. Therefore, an examination first determines what the issue is, and only then is the procedure chosen.
Where does an atheroma most commonly occur?
An atheroma can appear on any part of the body with hair follicles, but it is most commonly noticed on the face, neck, behind the ears, on the back, chest, and shoulders.
Atheroma on the back and shoulders it often grows larger before it is noticed, because it is out of the field of vision. Due to pressure and friction against clothing, it can become inflamed more frequently.
On the face and cheek It is usually noticed earlier, while it is smaller. When dealing with changes on the face, special care is taken regarding the incision and the future scar, and the removal method is determined by the doctor after an examination.
Behind the ear and on the neck it often gets in the way when combing, shaving, or wearing jewellery.
On the scalp A similar lump is often a trichilemmal cyst, which is distinguished from an atheroma upon examination.
What causes an atheroma to form?
Cysts of this type form when surface skin cells find their way into a deeper layer and form a capsule that gradually fills with keratin and sebum. The contents are thick, whitish-yellow and have a characteristic odour. The tendency for them to appear is partly hereditary. The lesion sometimes also forms at the site of a previous injury, irritation or blocked hair follicle. An atheroma is not the result of poor hygiene and cannot be transmitted from person to person.
When is it recommended to remove an atheroma?
Removal is considered when a cyst grows, interferes with dressing, combing or shaving, when it becomes repeatedly inflamed or when it presents an aesthetic nuisance — especially on the face and neck. A small lesion that causes no discomfort does not have to be removed immediately and the doctor may suggest monitoring. If you are not sure what kind of lesion you have, the first step is dermatological examination, at which the change is assessed and the further procedure is agreed upon. An examination also makes sense in the case of a change that is growing rapidly, changing its appearance or is painful.
What does the removal of an atheroma look like?
In everyday speech, the procedure is often referred to as an atheroma operation, although it is a minor intervention performed on an outpatient basis under local anaesthesia. Before the procedure, the doctor examines the growth and asks about previous inflammation, prior interventions, any medication you are taking, and allergies. Following an agreement on the procedure, local anaesthesia is administered.
Injecting the anaesthetic may sting briefly. Once the anaesthesia starts to take effect, the treated area is numb, so during the procedure usually only pressure or touch is felt. If any discomfort occurs, it is enough to tell the doctor during the intervention. For minor lesions, the procedure usually takes 15 to 30 minutes, along with the preparation. Upon completion, you will receive wound care instructions and a follow-up plan.
Methods of atheroma removal
Surgical removal of an atheroma
Surgical intervention removes the cyst along with its capsule. Draining the contents and complete removal are not the same procedure: when the capsule remains in the skin, the cyst most frequently fills up again. Therefore, whenever possible, the entire capsule is removed.
Depending on the size and location of the procedure, the wound is closed using an appropriate technique. If non-absorbable stitches are used, the doctor determines the date for their removal according to the healing progress.
Removal of atheromas by radiowaves
A radiowave instrument is used for selected minor changes when the doctor assesses that such an approach is appropriate for the finding. In our practice, these are most commonly changes up to 7 mm, but the decision is not made based on the diameter of the cyst alone — its position, depth and previous inflammation are also important.
Before the procedure, the doctor explains the method of removal, whether wound closure is necessary, and what kind of healing is expected.
histopathological analysis
According to the doctor's assessment, the removed tissue is sent for histopathological analysis, which confirms the type of lesion. The results are obtained within the agreed timeframe and are reviewed at the follow-up appointment, along with an assessment of wound healing.
What if an atheroma is inflamed or ruptures?
Redness, swelling, warmth and pain are signs of inflammation and a reason for a check-up, but they do not automatically mean a bacterial infection. A doctor assesses whether treatment for the inflammation, drainage or antibiotic therapy is necessary — the decision is made based on the clinical finding, not as a rule. If a cyst bursts on its own, the discharge of its contents does not mean the capsule has been removed as well: the lump most commonly refills. An epidermoid cyst should not be squeezed or removed at home, because the contents then easily spill into the surrounding tissue, and the inflammation worsens.
In the event of a high temperature, spreading redness or increased pain, an examination without delay is necessary.
Recovery after atheroma removal
Wound care depends on the site of the procedure and the way the wound was closed, so specific instructions are given immediately after the intervention — when to dress the wound, when it is allowed to get wet, and when it is possible to return to physical activities. Once the effect of the anaesthesia wears off, mild sensitivity in that region is possible. The wound must not get wet for the first two days, and swimming pools, saunas and strenuous exercise are postponed until healing, or until the stitches are removed. The date for stitch removal is determined individually, according to the site of the procedure and the course of healing.
Returning to normal duties also depends on whether the work involves physical exertion or friction at the site of the procedure. If the pain worsens, redness spreads, a fever develops or bleeding does not stop, you should contact the clinic.
Will there be a scar left?
After removing a skin cyst, a mark may remain. Its appearance depends on the size of the lesion, the site of the intervention, previous inflammation and individual healing patterns — scars on the back and chest are generally more noticeable than those on the face and neck. Careful planning of the procedure and proper wound care aim to make the mark as inconspicuous as possible.
People who have previously had raised or widened scars should mention this to their doctor before the procedure, as this information affects the choice of wound closure technique and post-procedure care.
What to tell the doctor before the procedure?
The medication you are taking – especially blood-thinning medication.
Allergies – to medicines, local anaesthetics, patches or disinfectants.
Previous inflammations of the same changes – whether the atheroma has already ruptured, been drained, or treated with antibiotic therapy.
Healing process – whether previous wounds left raised or widened scars.
Pregnancy or breastfeeding – the procedure is then planned in consultation with a doctor.
Cost of atheroma removal
The price depends on the size and location of the lesion, the chosen method and the scope of the procedure. For smaller lesions the procedure is simpler, while larger cysts require wound closure and healing monitoring, and histopathological analysis is charged separately when performed.
Current prices can be found in dermatology price list. Following the review, you receive a treatment proposal and information on the total cost.
Who performs the removal of an atheroma?
Frequently asked questions about atheroma removal
Can an atheroma recur?
Yes, especially if the capsule was not completely removed or if the cyst ruptured before the procedure. For this reason, the lesion is removed along with the capsule. Regardless of this, a new cyst may also form in another location.
Is an atheroma the same as a lipoma?
No. An atheroma is a cyst in the skin or directly beneath it, filled with keratin and sebum, whereas a lipome is a collection of fatty tissue in a deeper layer. A lipome is usually softer, more mobile and without an opening on the skin surface. The difference is determined by an examination.
Is an atheroma the same as a sebaceous cyst?
In everyday speech, yes, the term “sebaceous cyst” is used for the same thing as an atheroma. Medically speaking, the name is not entirely accurate, as an atheroma (epidermoid cyst) contains predominantly keratin rather than sebum. Removing a sebaceous cyst is therefore the same procedure as removing an atheroma, and the type of cyst is confirmed by examination.
Can an atheroma be removed while it is inflamed?
First, the inflammation is treated. In inflamed tissue, the capsule is more difficult to remove in its entirety, so final removal is usually planned once the condition settles. During the examination, the doctor assesses whether drainage or another procedure is necessary.
Is the procedure painful?
The procedure is performed under local anaesthesia. The injection of the anaesthetic may sting briefly, after which mainly pressure and touch are felt. Once the anaesthesia wears off, mild tenderness is possible in that area.
When can I return to work?
For minor changes in areas that are not under stress, a return is usually possible as early as the next day. If the job involves physical exertion, sweating or friction at the site of the procedure, the doctor gives specific advice following the intervention.
Can an atheroma go away on its own?
A cyst with a capsule does not usually go away on its own. The contents sometimes partially escape through an opening on the surface, but the capsule remains in the skin and the lesion typically refills.
Is the removed tissue sent for analysis?
Following the doctor's assessment, the removed tissue is sent for histopathological analysis, which confirms the type of lesion. The findings are reviewed at the follow-up appointment.
Can an atheroma be dangerous?
An atheroma is a benign skin lesion. It most frequently causes symptoms when it grows, causes discomfort or becomes inflamed. However, a lesion that grows rapidly, changes appearance, hurts or bleeds should be examined by a dermatologist, as an examination confirms what type of lesion it is.
When the procedure is postponed
In cases of pronounced inflammation, definitive removal is most commonly postponed until the condition settles. In inflamed and softened tissue, the capsule is more difficult to remove in its entirety, meaning the likelihood of the cyst recurring is higher. During this period, the doctor manages the inflammation and schedules a follow-up appointment.
Schedule the removal of an atheroma in Belgrade
The Imedic Polyclinic is located at Kneza Miloša 23 street, 2nd floor, Belgrade. Opening hours: Monday–Sunday, 9:00–21:00.
Appointments are made by phone: 064 237 0707. If you contact us from abroad, we are also available via Viber and WhatsApp on the same number.
Author: Dr Ivica Jeremić
Doctor of Medical Sciences (Molecular Medicine and Immunology), subspecialist in rheumatology, dermatology resident.
Updated:
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