What do they do for a ganglion cyst, the second time it happens?

Excision: This depends how much pain or problems the cyst causes. Some people dislike the appearance of these. Also it depends where the cyst is located, the next treatment would be surgical removal, given that these usually recur with needle drainage.

Your choice: Risk of recurrence after aspiration is 50%. Risk after surgical excision is 15%. Ganglions are benign. If they don't hurt, you don't need to do anything. If tit bothers you, you can drain it or excise it. You need to decide what is best for you.

See a hand surgeon: There are a lot of doctors who will take the bump off only to have it return soon after. Someone who is comfortable operating on the hand will seek out the origin of the cyst and reduce your chances of reoccurence. Good luck.