Adult males commonly have very thick skin on their backs, sometimes so thick it will bend needles when inserted. Thanks to my patient for sharing his procedure, it was a good one! This patient had very thick skin and significant scar tissue around his cyst. We were able to prevail with persistence! “No cyst left behind”. The contents were interesting, at the top moist and peanut butter like in appearance, deep down in the sac it was your typical dry grayish large skin flakes. With a mass like this it can be very difficult to infuse lidocaine directly underneath the growth, so you will see as I slowly peel back the wall with the blade I have to infuse more lidocaine in the bottom of the pocket, this is a common occurrence with growths over 5cm. The patient did great! Dermatology procedure. Dermatology Physician Assistant. Excision and closure. Running stitch. MrPopZit.