Let's Talk: Lumps, bumps, cysts and masses

So, what is that lump under my skin?

Lumps or masses under the skin are extremely common.  Most are benign (harmless) and do not require any treatment. On the surface, skin lumps and masses can all look very similar making it difficult to distinguish one type from the next with an untrained eye. You can actually learn more about the type of skin lesion you might have by feel and looking for the subtle differences described here! Our general surgeon, Dr. Kimberly Suppes, is talking about all things lumps and bumps.

Common Skin Masses:

Types of Cysts

Cysts are sacs containing material secreted by the actual lining of the cyst. These are full of normal skin structures and normal products made by the skin.  There are 3 main types of cysts:

1. Sebaceous cyst: These occur anywhere on the skin and have a point of attachment to the underside of the skin, which means they’re stuck in one place and you can’t move them freely from side to side.  They are smooth and relatively round, actually starting from normal glands which make oils to moisturize the skin. When the gland does not excrete properly the oils and other contents are trapped and begin to accumulate in the cyst. Occasionally, a pore can be seen and white, thick, cheesy content may come out when squeezed. (But don’t squeeze it! )
   
   
2. Epithelial inclusion cyst: These also occur anywhere on the skin and have a point of attachment to the underside of the skin. They are smooth and relatively round. These sacs are lined with normal skin cells which are cut off from the skin.  Therefore, as skin grows and sloughs normally, the old skin cells are trapped and collect in the sac. As you can imagine, the contents of these cysts are flaky, like peeling skin.
   
   
3. Pilar cyst: These occur on the scalp.  They are also attached to the underside of the skin and feel round and firm.  They evolve from glands on hair follicles and collect trapped secretions from the follicle. The contents are a pasty gray or whitish color.

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Cysts are typically larger than a pimple, have an opening to the skin, and are not surrounded by a sac. As pimples do not have a sac, no surgical removal is needed.

You should not attempt to squeeze an intact cyst, because squeezing makes it much more likely to get infected.  On the rare occasion, a cyst may rupture spontaneously. In this event, you should get it looked at by a primary care provider or surgeon.

All of these cysts are harmless and do not need to be removed unless symptomatic such as uncomfortable, rubbing, irritating or interfering with activities.  Cysts can be involved with the next type of skin lumps (infected abscesses) and when a cyst becomes infected treatment is needed by a primary care provider or a surgeon within 2-3 days if at all possible.

Abscess

Abscesses are pockets of pus and can occur anywhere in the body where bacteria have invaded.  Abscesses of the skin can be associated with any of the cysts already described when bacteria get into the trapped contents of the cyst or they can arise without previous lesion, especially at the site of an injury such as a cut, scrape, wound or any unnatural opening on the skin.  Abscesses are tender and red.  Swelling associated with the bacterial infection will make them increase in size rapidly.

All abscesses need to be treated in a relatively short time frame (2-3 days) as the infection will progress.  Initial treatment is generally drainage of pus. Oral antibiotics might also be required. If the abscess arises from a cyst, the cyst will need surgical removal after the infection is treated because the recurrence or likelihood of re-infection is high.

Those who are more susceptible to infection, such as patients going through treatments for cancer, diabetics or with any immune deficiencies, tend to be more prone to abscesses.

Lipomas

Lipomas are encapsulated fatty growths under the skin which are usually not attached to the skin. They are soft, smooth, and frequently mobile meaning they don’t feel attached to anything if you move them side to side. They are made entirely of fat cells trapped inside of the capsule.  These can get quite large!

Lipomas are removed when interfering with activity or rarely because of unusual or concerning features such as rapid growth or if any area of the lipoma feels firm.

Small lumps, whether cysts, abscesses or lipomas can often be removed in the office under local anesthetic. Small lumps under an inch in diameter are often removed in the office by a primary care provider. Larger or complicated lesions (for example, previously infected) may require surgical excision in a surgery center.

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For more information about Skin Lesion Removal:
• Lipoma
• Abscess
• Cyst

Learn more about Dr. Suppes

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