Infected epidermoid cysts should be incised and drained (I&D) and time allotted for the infection to resolve. If the walls of an epidermoid cyst rupture, which is usually associated with trauma, the contents within come in contact with the surrounding soft tissue, causing an inflammatory response indicated by symptoms including erythema, warmth, and mild discomfort [1]. Treatment of an inflamed cyst is not necessary unless requested by the patient or it progresses to an abscess. Inflamed epidermoid cyst walls are friable making successful remove of the entire cyst wall difficult. The use of curette to scrape the walls of an inflamed cyst may be necessary to remove all wall remnants. Recurrence is less likely if the cyst is removed when not inflamed. There is increase risk of cellulitis with I&D of an inflamed, non-infected cyst [1, 4, 5] (Fig. 44.3).

The location of the lesion requiring excision will determine the positioning of the patient. Proper positioning provides access for the clinician while providing comfort for the patient. The surgical site should be prepped and draped appropriately. Local anesthetic can be utilized in most instances. Monitored or general anesthesia may be appropriate in some cases with large lesions where proper positioning requires the patient to be sedated.