# "Partial" excision sebaceous cyst.



## lindacoder (Jun 13, 2011)

Don't think I have ever come across this before. Procedure note reads:

Patient, after verbal consent, was placed in the prone position. The left upper back was sterilely prepped and draped in the usual fashion. 1% lidocaine with epinephrine was then used to infiltrate the skin and surrounding edges of a fairly large sebaceous cyst. An elliptical incision was performed transversely including the punctum of the underlying sebaceous cyst that was on the skin. Using careful dissection the skin was excised; however the sebaceous cyst was extremely adherent to the underlying skin surface thoughout the extent of the palpable lesion which was approximately 5-6 cm in diameter. Therefore, the cyst was entered with release of a copious amount of sebaceous material. I then excised as much of this as possible, however, there were adherent areas of the capsule still within the bed most likely. Hemostasis wzas good. The wound was copiously irrigated out with sterile saline solution. The wound was then reapproximated with multiple vertical mattress sutures as we as several interrupted sutures. 
Patient was counseled that due to the amount of persistent inflammation that it was not possible to excise the cyst today; therefore I plan to continue him on antibiotics for a week. I will reevaluate him in a few weeks with removal of sutures and allow approximately 6 week intervals for the residual cyst to involute down to its original size. Once it is much smaller, I anticipate that we will be able to excise this with complete excision of the capsule. 

I really don't like I&D complicated because he used sutures as well as I don't like I&D simple because he did use suturesand I'm not sure about billing out a "partial" cyst excision.  Any thoughts will be appreciated.


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## deborahcook4040 (Jun 14, 2011)

presuming he sent the specimin to pathology, I'd go with "biopsy" rather than mass excision. The only difference between an excisional biopsy and a mass excision is that during the excisional biopsy you don't take the entire mass. Right?

21925 - Biopsy, soft tissue of back or flank; deep.

What I would do


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## daharden (Jun 20, 2011)

lindacoder said:


> Don't think I have ever come across this before. Procedure note reads:
> 
> Patient, after verbal consent, was placed in the prone position. The left upper back was sterilely prepped and draped in the usual fashion. 1% lidocaine with epinephrine was then used to infiltrate the skin and surrounding edges of a fairly large sebaceous cyst. An elliptical incision was performed transversely including the punctum of the underlying sebaceous cyst that was on the skin. Using careful dissection the skin was excised; however the sebaceous cyst was extremely adherent to the underlying skin surface thoughout the extent of the palpable lesion which was approximately 5-6 cm in diameter. Therefore, the cyst was entered with release of a copious amount of sebaceous material. I then excised as much of this as possible, however, there were adherent areas of the capsule still within the bed most likely. Hemostasis wzas good. The wound was copiously irrigated out with sterile saline solution. The wound was then reapproximated with multiple vertical mattress sutures as we as several interrupted sutures.
> Patient was counseled that due to the amount of persistent inflammation that it was not possible to excise the cyst today; therefore I plan to continue him on antibiotics for a week. I will reevaluate him in a few weeks with removal of sutures and allow approximately 6 week intervals for the residual cyst to involute down to its original size. Once it is much smaller, I anticipate that we will be able to excise this with complete excision of the capsule.
> ...



To me, this is an I&D, unless he sent a specimen to pathology.  The patient will probably come back  sooner though since he closed an infected wound.


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