Surgical Excision Versus Incision and Drainage for Epidermoid (Sebaceous) Cysts: A Systematic Review

Epidermoid cysts, commonly referred to as sebaceous cysts, are frequently encountered benign cutaneous lesions managed using a variety of surgical techniques. This systematic review aimed to evaluate the outcomes of different management strategies, with particular focus on recurrence and postoperative complications. A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted from database inception to December 2025 in accordance with Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five studies involving a total of 1,303 patients met the inclusion criteria. Complete surgical excision was consistently associated with lower recurrence rates compared with incision and drainage, while minimally invasive and CO₂ laser-assisted techniques demonstrated favourable cosmetic outcomes with acceptable complication rates. The evidence suggests that complete excision, including removal of the entire cyst wall, remains the preferred management strategy to minimize recurrence, although further prospective studies are required to strengthen the evidence base.