What is the optimal surgical approach to the treatment of digital mucous cyst?

Updated: Jul 31, 2018
  • Author: Murad Alam, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Overall, significant disagreement exists in the literature regarding optimal treatment approaches.

Dermatologists tend to favor more conservative treatments such as multiple needling or aspiration followed by steroid injection; they have reported high success rates and relatively low risks of recurrence.

Hand surgeons have noted success and rare recurrence with osteophyte excision and debridement, but their patient population is comprised of those who fail other treatments. All of the literature is biased toward the minority of patients who seek medical care for their digital mucous cysts. Asymptomatic cysts and spontaneous regression appear to be common, with several series suggesting that the likelihood of the latter may approximate 50%.

Additionally, as the aggressiveness of interventions to treat digital mucous cysts increases, the associated costs also increase. Conservative treatments offer the prospect of low cost, low morbidity, and the elimination of disability and time loss related to recovery from surgery.

Consequently, a reasonable treatment plan for symptomatic digital mucous cysts may entail initial needling or aspiration and injection; if these modalities fail repeatedly, patients may be referred to a hand surgeon for more radical surgery but must be forewarned of the increased risk of complications and offered the option of simply deferring treatment for this essentially benign entity.


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