The most common kind of cyst on the scalp is a growth known as a pilar cyst or a trichilemmal cyst. Many people first notice them when they are brushing or combing their hair. This kind of cyst can grow anywhere on the body, but it is most common on the scalp, and anyone can get them, but they are most common in middle-aged women, and are generally more common in women than in men. They occur on the scalps of people of all races. Children of parents who have pilar cysts have a 50-50 chance of developing cysts of their own; the gene for the problem is dominant.
What Are Pilar Cysts?
About 70 percent of the time, there is more than one cyst. A pilar cyst is usually skin-colored, firm, round, and mobile. It can be pushed around by pressing at its edges. They can become, red, swollen, inflamed, and tender if they become infected.
This kind of skin growth occurs between the muscle underlying the skin and the opening of a pore that produces sebum, the oil that lubricrates the skin. The skin makes keratin, the protein that protects it very fast, and a bump grows around the pore. It's very rare for a pilar cyst to become cancerous, but they can grow up to 25 cm (6 inches) across.
The doctor typically numbs the skin, and then injects a second anesthetic into the skin over the cyst itself. He or she cuts the skin over the cyst, and, since pilar cysts usually are surrounded by a capulse, the doctor pulls it out whole. Sometimes a cyst can be "marsupialized" (with a pouch like that of a marsupial, such as a kangaroo), containing a toothpaste like substance that can ooze out on its own or be removed during the surgery.
Usually surgical excison of the cyst cures it. When there are multiple cysts, or when a cyst has penetrated the scalp, radiation therapy may be required.
Getting treatment for pilar cysts is not cheap. If you are in the US and you do not have insurance, the initial consultation will usually cost about $350 to $500 and the procedure another $500 to $1000. Medications will cost another $100. Most Americans who have medical insurance wait until the end of the year to have the procedure, when they have met their deductible or maximum out-of-pocket expense for the year. If you have insurance, then your copay will usually be the same as for an office visit, because the procedure is done in the doctor's office.
Could You Have An Epidermal Inclusion Cyst Instead?
There is one other kind of non-cancerous, non-infectious cyst that can occur on the scalp, an epidermal inclusion cyst. In this kind of cyst, the topmost layer of skin, the epidermis, starts growing down as well as up. This kind of cyst can occur on the scalp, but it is more common on the chest, face, and neck. It is caused by either exposure to too much UV light of the sun, or human papillomavirus infection. If you have the same kind of cyst on your scalp and your face or your scalp and your neck or trunk, it is more likely to be an epidermal inclusion cyst. In people who have darker skin, the cyst is more likely to be black. Unlike pilar cysts, this kind of cyst can be tiny, forming a row of black dots on the face or scalp.
Epidermal inclusion cysts are also removed surgically. The entire cyst has to be removed or it will come back. For that reason, it is important to let the doctor treat this kind of cyst. Costs are about the same as for treating pilar cysts.
Skin Cancer On The Scalp
It's also possible to get skin cancer on the scalp. Basal cell carcinoma will look like a tiny pearl (at first), with a round or oval shape. It may itch, burn, and bleed. Melanoma often has a bluish tint. and usually has irregular borders. Squamous cell carcinoma forms a non-healing ulcer on the scalp that just won't go away. If you just think you may have skin cancer, it is always a good idea to go to your doctor for a definitive diagnosis.
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