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Dermatologic Manifestations of Mucous Cyst Treatment & Management

  • Author: Christopher R Shea, MD; Chief Editor: William D James, MD  more...
 
Updated: Jun 06, 2016
 

Medical Care

Patients with asymptomatic, superficial mucous cysts may require reassurance only. Partial or total electrodesiccation and intralesional injections of triamcinolone acetonide have been reported as treatments for mucous cysts. Topical clobetasol propionate 0.05% has been reported as an effective intervention for multiple, recurrent mucous cysts.[20]

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Surgical Care

For definitive management, if indicated, the minor salivary gland may be excised, just as in cases with persistent irritation.

The treatment of choice for a deep mucous cyst and the classic form is surgical excision, which should include the immediate adjacent glandular tissue.

Cryosurgery with liquid nitrogen spray or cryoprobe is an alternative therapeutic modality.[21, 22] After day 4 to week 1, a necrotic surface is observed in the treated area. The latter separates from the surrounding mucosa in 1-2 weeks, exposing a new epithelialized surface. The advantages of the procedure include a simple application, minor discomfort during the procedure, and a low incidence of complications (eg, secondary infection, hemorrhage); however, the possibility of recurrence exists.

Another therapeutic strategy is argon laser treatment, typically administrated at a constant pulse duration of 0.3 seconds, using a laser beam diameter of 1.5-2 mm and a power setting of 2-3 W. Lesions presenting as firm nodules are treated with a continuous exposure and a power setting of 2.5-3.5 W. The necrotic area posttreatment is well defined by day 8-12, with complete wound healing in approximately 2 weeks. The only reported complications are swelling and mild discomfort for up to 10 days.[23] The advantages of argon laser over cryosurgery consist of less discomfort in the postoperative period, less edema and irritation, and a reduced healing time. A disadvantage of this therapeutic alternative is the requirement of specialized equipment.

The use of carbon dioxide laser appears to be a superior treatment modality for mucous cyst, with minimal recurrence.[24] It has the advantages of allowing precise surgical technique, lack of bleeding for a clear operation field, minimal wound contraction and scarring, and a short operative time.[25, 26, 27] As such, it has been proposed to be particularly useful in the treatment of those who are intolerant of long procedures, including children. A disadvantage is the requirement of expensive, specialized equipment, and necessary protection for both the patient and physician performing the laser vaporization.[26]

Erbium laser treatment has also been described in a pediatric patient, with excellent results.[28]

Diode laser vaporization (940 nm in contact mode) was used successfully in one reported patient with an extravasation-type mucous cyst of the lower lip.[29]

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Consultations

Possible consultations may include the following:

  • Dermatologist
  • Dermatologic surgeon
  • Oral medicine specialist
  • Oral surgeon
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Complications

Secondary infection and local bleeding have been reported as rare complications. Traumatic neuroma may occur as a sequela following laser or cryosurgery.[30]

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Contributor Information and Disclosures
Author

Christopher R Shea, MD Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago, The Pritzker School of Medicine

Christopher R Shea, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology, Association of Professors of Dermatology, International Society of Dermatopathology, Arthur Purdy Stout Society, Chicago Dermatological Society, Dermatology Foundation, Illinois Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Markus D Boos, MD, PhD Assistant Professor of Pediatrics, University of Washington School of Medicine

Markus D Boos, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

David P Fivenson, MD Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan

David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Michigan State Medical Society, Society for Investigative Dermatology, Photomedicine Society, Wound Healing Society, Michigan Dermatological Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, M. Angelica Selim, MD, to the development and writing of this article.

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The submucosa shows a mucin-filled, cystlike cavity below the squamous mucosa. Minor salivary gland lobules are present in the submucosa.
The wall of the lesion is usually formed by connective tissue, inflammatory cells, foamy macrophages (lower left corner), and salivary gland acini (upper right corner).
 
 
 
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