(Wen; Atheroma; Sebaceous cyst)
Definition. A variously sized, elevated, round, soft or firm, painless, tumor- like sebaceous cyst, larger than milia, located in the skin or subcutaneous tissues.
Symptoms. Wens are usually found upon the scalp, face, neck, back and scrotum but they may rarely occur on other parts. They vary in size from that of a pea to an egg, grow slowly, cause no pain or discoloration of the covering skin unless they become inflamed. There may be one or several tumors but they are rarely numerous. Usually round or avoid in shape, a few may appear flat on the top or irregular in outline. They may be variously situated beneath, within or upon the skin but are rarely attached to the deeper tissues. Occurring on the scalp, the hairy covering may be sufficient to render them only slightly noticeable but usually the coexisting baldness advertises them freely. The duct of the gland is usually closed, though in some cases the opening is sufficient to press out the contents of the cyst which promptly refills. To the touch wens are doughy or elastic as they are flaccid or tense but inflammation gives them a softer feeling. Ulceration or suppuration may follow continued inflammation or secondary infection.
Etiology and Pathology. It is commonly believed that most wens are retention cysts with the enveloping wall caused by counter thickening of the glandular covering from pressure. Chiari and others believe that the majority of steatomata are dermoid in character and arise from embryonic remnants in the skin. In any case their contents consist of more or less changed sebum, broken- down epithelia, cholesterin crystals, detritus and, occasionally, rudimentary hairs and limesalts. They may vary in consistency from a granular, cheesy semisolid to a milk-white fluid, and connective tissue new-growth, atheromatous and calcareous degenerations have been noted.
Diagnosis. Lipomata are lobulated, give a “pillowy” sensation to the touch and are situated about the shoulder blades, loins and buttocks in nearly all cases. Syphilitic nodules are painful and tender to pressure and evidences of other lesions or a history of syphilis may be found. Furuncles and circumscribed abscesses may be differentiated from broken-down wens because they are more acute in their development and tend more readily to suppuration without any marked causal irritation.
Prognosis and Treatment. These growths are benign but show no tendency to disappear spontaneously. It may be necessary, because of their inconvenience and disfiguration, to remove them. Excision with strict antiseptic precautions is not only the most sensible but the surest method. I have never seen other than good results if the following technic is observed; the parts over the cyst having been incised, the cyst wall with its contents is carefully dissected out, the wound closed with or without sutures, according to its length or location, dusted over with iodoform or aristol, and covered with antiseptic gauze held in place by a bandage. Unless infection ensue, this dressing need not be removed for five to seven days. A local anesthetic such as an ethyl chlorid spray or cocain is usually employed. Small wens may be emptied by slight incision and the electric needle (electrolysis) applied at several points of the cavity but ordinarily this method or the use of caustics is not advisable.