Scrotal sebaceous cysts

Scrotal sebaceous cysts are lumps in the skin of scrotum. They are painless and typically have been there for months or years. They may remain unchanged in size and number but sometimes existing lumps can become bigger, or new lumps may appear with the passage of time.

Most patients have multiple cysts, and often there are cysts of different sizes. Often the attention is drawn by larger, more obvious cysts but examination will reveal other smaller lumps which can be felt in the thickness of scrotal skin, and these have not appeared above the skin surface.

These cysts are benign (harmless) and are rarely a cause for concern. If the cysts become infected they can become painful and may burst or discharge pus. Occasionally cysts become painful and infected after the patients have unsuccessfully tried to get rid of them at home by cutting through the lesion.

• Appearance: Scrotal sebaceous cysts appear as whiteish, yellowish or skin coloured lumps and are filled with a clear oily liquid or a putty like substance.
• Size: They can vary greatly in size, from 1-2 mm to larger ones measuring 1-2 cm each. In fact a typical patient can have lesions of different sizes at the same time.
• Number: Similarly they can vary in number from solitary lesion to scrotal skin studded with multiple cystic lesions. The cysts may occasionally cover the entire scrotum.
• Distribution: Scrotum is the commonest site for genital sebaceous cysts but can occasionally appear on the shaft of the penis or on the prepuce (foreskin). Multiple scrotal cysts often show a typical distribution pattern of being scattered around both sides of midline.

Scrotal sebaceous cysts can develop at any age but are usually first noticed in teenage years and early adulthood.

Scrotal sebaceous cysts can become infected, causing swelling, redness and tenderness around the cyst and they may burst, producing pus with a foul odour. If you are experiencing symptoms associated with an infection you should seek medical advice as this requires treatment with antibiotics.

Occasionally, small scrotal sebaceous cysts may go away on their own. The use of a warm compress a couple of times a day can help reduce the size of the cyst or swelling by encouraging the cyst to drain or reabsorb into the body.

However, larger cysts are unlikely to go away without surgical treatment.

Sebaceous cysts are caused by the sebaceous glands being blocked. The majority of the sebaceous glands are on the face and scalp, but are also present on all parts of the skin (except the palms of the hands and the soles of the feet). Essentially, a sebaceous cyst can appear anywhere where hair grows.

Sebum is a thick and greasy oil that is produced by microscopic sebaceous glands in the skin. The body produces sebum naturally to keep our skin moisturised and our hair healthy. Sebaceous cysts are caused by an accumulation of sebum which causes the sebaceous glands to block and cysts to develop.

No, a sebaceous cyst is not an STI, and it can not be transmitted to someone else through sexual contact. Sebaceous cysts are also not cancerous.

It is not always possible to prevent cysts from developing. Keeping your skin clean and maintaining good skincare is enough. Try to avoid shaving and waxing the hair on the scrotum as this can lead to ingrown hairs which can damage the hair follicles.

In some cases, there may be a genetic predisposition to develop sebaceous cysts.

Attempting to remove scrotal sebaceous cysts yourself can make them bigger and there is a high risk that the area will become infected and may scar.

A physical examination is usually enough to diagnose scrotal sebaceous cysts. An examination is only ever performed with your explicit consent, and your clinician will treat you with the utmost respect and dignity. You will be offered the presence of a chaperone during your examination.

In cases of diagnostic uncertainty or suspicious growth, a biopsy +/- HPV testing can be offered. This is usually not needed as it is common that a physical examination is enough to establish the correct diagnosis. Your clinician will be able to explain this in the appointment and answer any questions you may have.

Avoid shaving the area around the cysts before your appointment. This might cause irritation or an infection.

Unlike epidermoid cysts, which originate from the skin, and unlike pilar cysts, which come from hair follicles, true sebaceous cysts originate from your sebaceous glands. Your clinician will be able to tell the difference between these lesions in your appointment.

Other possible causes of scrotal lumps such as genital warts or molluscum contagiosum may be mistaken for scrotal sebaceous cysts. However, the size, texture and appearance of scrotal sebaceous cysts will usually mean your clinician will be able to confidently tell you what your diagnosis is.

Unless there is diagnostic uncertainty, confirmation beyond an examination by your clinician is not normally required.

Of course. We understand that you may wish for a second pair of eyes to assess your condition. You are more than welcome to book an appointment with another clinician as well - either at our clinic or elsewhere.

The prognosis with sebaceous cysts is excellent in most cases.

Most people who are treated with scrotal sebaceous cysts do not show recurrence of their lesions, and therefore do not need to return for further treatment. However, as with any treatment, this is not something we can guarantee.

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[faq_item question="Is there anything I can do to prevent scrotal sebaceous cysts from returning?" section="Prognosis"]

You do not need to do anything specific other than maintain a good hygiene and skincare routine.

As scrotal sebaceous cysts are not infectious or sexually transmitted there is no implication or concerns for your sexual partner(s). There is no requirement for you to share your diagnosis or its treatment with your partner(s).