Video: Steps for Cyst Removal

Epidermal inclusion cysts (EICs) are commonly seen at practice.  Depending on how the EIC presents, there are many surgical approaches. Some are easier to extract, while others can tunnel and adhere to surrounding tissue, making it time-consuming and a challenge.  

In these difficult cases, complete surgical excision can ensure removal of the sac and prevent recurrence.  However, the minimal excision technique is the most common procedure I like to perform when the EIC is not invasive, adhered, and not presenting stubbornly.  Patients heal well and it minimizes the incision and scar length.  

Here are 9 Simple Steps to Perform Slit Incision

Watch 🎥 VIDEO to get a better visual.

  1. Mark before anesthesia
  2. Perform a minimal 2 - 3 mm incision (typically incision is the length of the EIC), creating a slit with a #15 scalpel
  3. Express cyst contents and extraction of the cyst wall with lateral pressure using your fingers  
  4. As cyst contents are loosened, locate cyst wall with surgical hook
  5. Perform blunt dissection detaching cyst wall from the surrounding tissues to facilitate removal of the sac 
  6. Celebrate removal with your patient (At my clinic, most patients looove looking at it and that’s when we poke fun and even give it a name and gender! 🤣 )
  7. Small wound can be closed with a single deep suture
  8. Tie your knots
  9. Finish with a few epidermal simple interrupted sutures 

An alternative to this technique uses a punch biopsy instrument to create the opening into the cyst.  Even quicker to perform with this technique with comparable results!

Also, as we have all been there (and if you haven’t yet, you won’t forget it!), a few pearls to remember is don’t forget to wear your safety glasses because sometimes cyst contents can spray right on you!  Using gauze to cover the area as compression is applied, or a clear adhesive splatter-control shield, can be tremendously helpful!  

This will help prevent you from walking around clinic all day smelling like a walking cyst! In derm, we all know that smell and it’s not pleasant 😷! 

Master Your Skills

On SEPTEMBER 20th, my advanced suturing course will open up for enrollment and teach suturing techniques to help master your skills. The course will empower you with a simple framework to follow guiding you with a mindful approach to suturing, optimizing how your patient heals. 

Also, learning pitfalls to avoid to prevent those ugly scars and postoperative complications!

🗓 Mark this date on your calendar & click HERE to join the waitlist if you haven’t already! You will be first to get updates and the early bird special!

Also, earn 4.5 CME credits!

The course is called…

“Step-By-Step Framework on How to Close a Layered Excision for the Dermatology NP/PA”.

I’ll be walking you through a simple framework that has helped me build my confidence and improve how my patient heals!

I can’t wait to share what I’ve learned in the 10+ years of doing this to shortcut your learning curve! 

HERE'S WHAT PAST STUDENTS HAD TO SAY… 

  • “Very clear information. Not a lot of “fluff” and got right to the necessary information.” 

~ Cheryl Bourgault, PA

  • “I performed the set back dermal suture technique twice this week and was really happy.  Prior to seeing this video, I tried and it didn’t work. I didn’t appreciate the need for adequate undermining. Since I have been doing that, very pleased with the results. Able to put much less pressure on the external sutures.”

~ Tammy Cheater, NP

  • “Very helpful tips such as leaving some breathing room to reduce risk of track marks…I like the layout of the framework and how the recommended steps are broken down based on wound tension.”

~ Erica Scarr, PA

  • “The step-by-step slow videos are very helpful.  Will be a great guide to practice the techniques.”

~ Jaclyn Vinagre, NP

  • “I love the step-by-step instructions. Also how you explain the pros and cons.”

~ Patrice Simon, PA

  • “I appreciate the step-by-step instruction…explanation of pros and cons…information was very easy to understand…I like that the video stops for more explanation when needed.”

~ Nicole Keeter, PA

I am truly grateful and happy it helped them and hope to help you too! 

Serving with GRATITUDE,

Theresa Talens DNP, FNP-C

P.U.L.S.E. Dermatology & Procedures, Inc.

Where we believe in Precision. Ultimate Care. Leverage. Skills. Excellence.

Online suturing course re-opening up for 3 days only for a New Years Special on Jan. 1-3 ~$100 OFF!

 

This online, self-paced course is for dermatology NPs/PAs that perform or plan to perform excisions.  The course will help you master your technique, minimize scarring, and optimize your patient's outcomes. Enrollment is opened only for 3 days so don't wait (8 CMEs). Once you enroll, you get immediate access and can start learning at your own pace. Life-time access! Opens Jan 1-3.

Join Waitlist for On-line Self-Paced Course

Enrollment open for only 3 days, January 1-3. Don't wait!

  In-Person FULL-DAY suturing workshop coming soon!  Only 10-20 seats available! Join waitlist to guarantee your spot on Oct 17, 2025!

 

P.U.L.S.E. © will have a FULL DAY in-person suturing workshop coming soon on October 17, 2025 (7.5 CMEs)! 

This workshop will be held at the stunning beach resort in Virginia Beach, Virginia!

Master your suturing techniques and build your confidence!

A workshop finally created and designed for dermatology NPs and PAs who perform or aspire to perform excisions and want to master their skills further.

There are only 10-20 seats available so join the waitlist for the workshop to guarantee your spot! 

Join Waitlist for In-Person Workshop Shop October 17, 2025

Only 10-20 seats available!

❝ Testimonials From Past Students ❞...

Allison McKean, PA

"This was the most complete and organized training I have ever received regarding excisions. This should be required for any provider, not trained in a residency, who is or plans to do excisions."

Joy Green, PA

"The information was extremely digestible and straightforward. I was able to catch on quickly and apply these skills in my practice, almost immediately. I love the lifetime access and being able to quickly review each video on the go, during downtime at work and as a continual reference point post surgery."

Francesca Burgi, PA

"Yes, love all the visual learning! This course is EXCELLENT! Thank you for all the hard work you put into this - it shows and we are lucky to learn from you! It gets to the point! It is great for where I am in my career right now. I do excisions but I defer so many because I didn't know some of these techniques.This course gets straight to the techniques and problem-solving skills we need to maximize our patient's surgical success."

Marshall Logan, NP

"If you have never had a chance to sit in a classroom setting to understand suturing, this is a lifetime jewel for NP, PA and others that provide a wealth of knowledge to assist in your daily experiences.  Finally, a colleague that is competent and willing to share her knowledge for greater efficiency of the industry!!! Thank you Theresa, you are wonderful!!"

Jayson Keener, PA

"In today's era of medicine it is so rare to find a provider, MD, PA, NP that will take time outside what is an already very busy patient care day for themselves, to educate and help their peers. With this course you can clearly see how much Theresa values not only the patients she cares for on a daily basis but also that her peers are educated, confident, and mentored. This course without a doubt is the best value I've seen. Sign up today, don't wait, do it now, you won't regret it. Thank you Theresa, I'm so glad I took this course!!

Amy Jones, PA

"Whether you are just beginning excisions in your career or have been doing them for a decade on not improving this course is for you...I have been searching for something like this for a few years...this gives me a...deeper understanding of what I was already doing...and there are real techniques you can apply right away that will immediately build confidence and lead to better patient outcomes."

 

Nadine Bedrosian, PA

"Videos were nicely organized, easy to follow - The FB discussion group for continued support - Theresa is very knowledgeable and responsive to questions and concerns. Theresa is a wonderful mentor. I appreciate the time she took to provide this course with valuable pointers she learned in her career to help out those just starting."

Stacey Cilli, PA

"It was very clearly laid out and organized. I loved seeing the examples of each suture type in real time. I love to see entire surgeries from start to finish with voiceover explanations on best practice and technique for different body areas. Excellent course. I recommend it to any PA/NP who is looking to improve their suturing skills."

Courtney Mich, PA

"I thought this course was very well developed and put together. I enjoyed the step by step processes and case studies that were showed."

Katie Rauchwarg, PA

"This was a great introductory and review course of the basics needed for surgery! I would recommend this course for any PA/NP that is looking to refresh their knowledge or begin working with a Mohs surgeon."

Paige Venables, PA

"This would be a great course for any mid level provider who performs excision.  It reiterated a lot of my current techniques and explained why these techniques are appropriate. I liked the videos and algorithms…the info on suture material and size."

Patrice Simon, PA

"The course is helpful for anyone who does not feel confident about suturing technique. The step by step tips are wonderful. Also the clinical pearls from a seasoned pro is so helpful. I like that it was self paced and that I could go back and review videos. I also love how responsive Theresa is to feedback and questions."

Madeleine Adams, NP

"This course if perfect for a new or even 1-3 year experienced dermatology provider. It solidifies the framework to take into practice. Would highly recommend!"

Cheryl Bourgault, PA

"This course has good basic info as well as some more intermediate info on suturing that I had not been exposed to before. The info was clearly presented at a good pace. I will definitely be using some of the techniques I learned in my upcoming surgeries."

Irasema Gonzalez, PA

"If you're new to suturing this is a great foundation and basis, highly recommend!"

Leah Rae Sylvester, PA

"Good introduction and reminders for those independently suturing and performing surgery."

Elizabeth Anne Russeau, NP

"I would definitely recommend this course to others. I found it clear, concise, and thorough. I'm excited to implement the framework into my practice."

Lisa Sheehan, NP

"It was great course for clear and conscience explanations and video techniques that you can practice along with. Very direct and clearly explained."

Kristine Jaye Adalla-Angeles, NP

"I appreciate that there were demonstrations and thorough explanations. I liked how there is a step by step guide, and appreciated the demonstrations. Great course! I already recommended it to my colleagues! "

Rosa Singleton, PA

"Material was provided in an easy to understand manner with great explanations and before and after photographs. It’s a good course to improve patient outcomes."

Kara Addison, NP

"I would recommend this course to provide a solid frame work to furthering already basic suturing skills."

Trisha Bartlett, PA

"Easy to follow. The photos were terrific. Loved how concepts were explained in different anatomical sites."

Chelsea Lettieri, NP

"Loved the course! It was clear and easy to understand with a lot of examples. I liked seeing real examples and step by step videos of suturing techniques."

Rachel Deets, PA

"I learned new techniques and I feel supported in techniques I already practice. It's reassuring to see that I am doing the best for my patients and am up to date with best practices. I would recommend the course for dermatology APPs in the 2nd or 3rd year of practice."

Rachel Quinn, NP

"Good review of techniques and tips to minimize scarring and complications."

Rachel Hinds, PA

"It was a good suturing course for beginners! Very easy to understand."

Megan Olson, NP

"This course very much helped me feel more comfortable with evaluating surgical defects and how to repair them with the best functionality and cosmetic appearance as possible!"