Comparison of complete surgical excision and minimally invasive excision using CO(2) laser for removal of epidermal cysts on the face

BACKGROUND: Epidermal cysts are benign, slow growing cysts that often develop on the head, neck, chest, and back of adults. The most common method of surgical excision involves the use of a scalpel and often leaves a scar proportional to the size of the cyst. Therefore, minimally invasive techniques are required. Among these techniques, the CO(2) laser-based technique is minimally invasive and has lower complication rate, shorter recovery times, and lesser scarring. This paper aimed to compare the results and postoperative complications associated with a CO(2) laser-based excision against conventional surgical excision for epidermal cysts. METHODS: We surveyed 120 patients, aged 16 to 65 years, with epidermal cysts on the face measuring 0.5 to 2.2 cm in diameter. Twelve months later, we compared the scar length, recurrence rate, patient satisfaction, and complications between patients treated with CO(2) laser excision versus surgical excision. RESULTS: The mean scar length (12 months postoperative) after CO(2) laser excision was 0.30± 0.15 cm, and that following surgical excision was 1.23± 0.43 cm (p= 0.001). The procedure time (time from incision after local anesthesia to the end of repair) was 16.15± 5.96 minutes for CO(2) laser excision versus 22.38± 6.05 minutes for surgical excision (p= 0.001). The recurrence rates in the surgical excision group and CO(2) laser excision group were 3.3% and 8.3%, respectively; this difference was not statistically significant (p= 0.648). CONCLUSION: The cosmetic outcome of CO(2) laser excision is excellent. For epidermal cysts measuring 2.2 cm or smaller, CO(2) laser excision is recommended, especially when aesthetic outcome is considered important.