scalp lesions - Cysts, Lipomas

Scalp lesions such as cysts and lipomas are common and usually benign. However, they may require surgical intervention, especially if they cause discomfort, cosmetic concerns, or other complications. Neurosurgeons can provide specialized care for these lesions, particularly when they are located near critical structures or have complex characteristics.

Types of Scalp Lesions:

1. Cysts:

• Epidermoid Cysts: Also known as sebaceous or epidermal inclusion cysts, these are the most common type of cysts found on the scalp. They are filled with keratin and can become infected or inflamed.
• Pilar Cysts: Also known as trichilemmal cysts, these arise from hair follicles and are typically filled with keratin. They are usually found on the scalp.
• Dermoid Cysts: Congenital cysts that can contain hair, skin, and other tissues. They are less common and can occur on the scalp.

2. Lipomas:

• Benign tumors composed of fat cells. They are soft, movable, and usually painless. Lipomas can vary in size and may sometimes grow large enough to cause cosmetic or functional issues.

Role of Neurosurgeons in Scalp Lesion Management:

1. Diagnostic Evaluation:

• Physical Examination: Assessment of the lesion's size, consistency, and mobility.
• Imaging: Ultrasound, MRI, or CT scans may be used to evaluate deeper lesions or those near critical structures to determine the precise nature and extent of the lesion.

2. Surgical Interventions:

• Excision of Cysts:
  Epidermoid and Pilar Cysts: Surgical removal involves making a small incision over the cyst, carefully excising it along with its capsule to prevent recurrence.
  Dermoid Cysts: These may require more intricate surgical planning, especially if they are deeply rooted or near sensitive areas.
• Excision of Lipomas:
  Simple Lipoma Removal: Involves making an incision over the lipoma, dissecting it from surrounding tissues, and removing it.
  Large or Complex Lipomas: May require a more extensive surgical approach to ensure complete removal and to address any potential complications.

3. Minimally Invasive Techniques:

• Endoscopic Removal: For certain cysts and lipomas, minimally invasive techniques can be used to reduce scarring and recovery time.

Indications for Surgical Removal:

• Cosmetic Concerns: Many patients seek removal due to the visible nature of these lesions.
• Discomfort or Pain: Lesions that cause discomfort, tenderness, or pain, especially when infected or inflamed.
• Functional Impairment: Large lesions that interfere with activities like combing hair or wearing hats.
• Infection or Inflammation: Recurrent infections or inflammation may necessitate removal.
• Uncertain Diagnosis: Lesions with atypical features or rapid growth that require histological examination to rule out malignancy.