Skin lumps and bumps

Skin Lumps

Bumps on your skin can be itchy, painful, or merely a nuisance, and they tend to get more widespread with age.

Skin lump and bumps are any areas of abnormally raised skin, either on the skin’s surface or protruding from under the skin. A person with a skin lesion has an abnormal lump, bump, ulcer or sore. A skin lesion may also be an abnormally colored area on the skin. Common skin lesions include moles, warts, actinic keratosis, and skin infections. A serious cause of skin lesions is skin cancer.

Most skin lumps are benign, meaning they are not cancerous, but they can be unsightly and feel painful or itchy. Skin lumps develop with more frequency as we age, are more likely to appear in areas with active sweat glands, such as the face and chest area, and are more common in people who have has a lot of sun exposure.

The lumps may be hard and rigid or soft and moveable, and are commonly caused by swelling due to an injury. While skin lumps generally don’t indicate a dangerous medical condition, and usually don’t interfere with everyday life, they should be checked by a doctor to screen for malignancy.

What causes skip lumps?

Symptoms associated with skin lumps offer visual clues to the cause.

A cyst is a closed pimple-like pocket under the skin filled with fluid or hard tissue. Most skin cysts are harmless, but they can grow and cause discomfort. For example, epidermoid cysts commonly appear on the face, chest and neck, appearing as white pustules. Check with your doctor or dermatologist if your skin cyst is inflamed, painful, oozing, or interfering with your daily activities. Most cysts can be treated with minor out-patient extraction surgery.

Cherry angiomas are common skin bumps that usually start appearing after age 30. Red and smooth, they are painless blood vessels and rarely require treatment, but they can be removed using laser surgery.

Dermatofibroma, or fibrous histiocytoma, are brown, pink or yellow marks on the skin that usually form where the skin surface has been damaged, by a nick or bug bite. Neither cancer nor cyst, these skin bumps are usually just a cosmetic nuisance.

Another non-cancerous skin lump is a keratoacanthoma. These appear suddenly, grow quickly, and are more common in people who have had a lot of sun exposure.

If you have a soft, mushy lump under your skin, it may lipoma. These extremely common skin lumps occur for a number of reasons, including prior injury to the area, but there may be a hereditary link. Lipomas most often strike people between the ages of 40 and 60. They aren’t dangerous and rarely require treatment.

Skin lumps can be caused by a number of health conditions that range in severity. Common types:

  • Trauma
  • Acne
  • Moles
  • Warts
  • Pockets of infection, such as abscesses and boils
  • Cancerous growths
  • Cysts
  • Corns
  • Allergic reactions, including hives
  • Dermatofibromas
  • Epidermoid cysts
  • Folliculitis
  • Keratoacanthoma
  • Keratosis pilaris

Skin Lump Treatment

The treatment for a skin lesion or lump depends on the type of lesion. Treatment for a skin lesion may include oral corticosteroid medications, topical medications, laser therapy, freezing the lesion, or surgery.

Skin lumps caused by injury usually fade on their own as the swelling goes down. Applying an ice pack and elevating the area can reduce inflammation and ease pain. You will need antibiotic medications to help the lumps heal if your skin lump is caused by an infection or abscess. Your doctor may prescribe topical medicines to eliminate acne bumps, warts, and rashes. Topical skin ointments and creams may contain salicylic acid or benzoyl peroxide. Corticosteroid injections are a possible treatment for skin lumps that become inflamed. Some skin lumps warrant surgical removal.

Bartholin’s cyst

If the Bartholin’s cyst is small and does not cause any symptoms, it’s often better to leave it alone. However, you should still see your doctor if you notice a lump.

If you have pain around the cyst, your doctor may recommend that you:

  • soak the cyst for 10–15 minutes in a few inches of warm water (it’s easier in the bath) – you may do this several times a day for three or four days
  • hold a warm compress (a flannel or cotton wool warmed with hot water) against the area
  • use pain relief, such as paracetamol or ibuprofen

Always read the manufacturer’s instructions when using over-the-counter (OTC) medication.

Treating an abscess

If the cyst becomes an abscess (a painful collection of pus), you may also be prescribed antibiotics to clear the infection.

Once the infection has been treated, your doctor may still feel it necessary to drain the cyst, particularly if the abscess is large.

Bartholin’s cyst incision and drainage

Drainage/balloon catheter insertion

When a Bartholin’s cyst or abscess is inflamed, it may simply be cut open and drained if this is possible.

An alternative procedure for draining a cyst is known as balloon catheter insertion, or sometimes catheter placement or fistulisation.

This procedure is used to drain the fluid from the abscess or cyst and to create a permanent passage to drain away any future fluid that builds up.

You will have balloon catheter insertion as an outpatient, which means you won’t need to stay in hospital overnight. It can be carried out under either local or general anaesthetic.

During the procedure, a cut is made in the abscess or cyst and the fluid is drained. A specially designed balloon catheter is inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.

The balloon is then filled with a small amount of salt water. This increases the size of the balloon so that it fills the cyst or abscess. If you have any pain, some of the solution can be removed to reduce the pressure slightly.

A stitch may be used to partially close the incision and the balloon catheter is held in place in the cyst. The catheter will stay in place while new cells grow around it (epithelialisation). This heals the surface of the wound but leaves a passage in place. This usually takes around four weeks, although in some cases it may take longer. After epithelialisation, the balloon is drained and the balloon catheter removed.

A few small studies have reported that, after balloon catheter insertion, 83–97% of women healed well and their cysts or abscesses did not reoccur.

Possible complications of balloon catheter insertion include:

  • pain from the catheter
  • pain during sex
  • swelling of the labia (the lips around the opening of the vagina)
  • infection
  • bleeding
  • scarring

Marsupialisation

If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used. In marsupialisation, the cyst is opened with an incision and the fluid is drained out.

The edges of the skin are then stitched in a way that prevents further fluid build-up by allowing it to drain out. This creates a pouch (similar to a kangaroo’s pouch, hence the name marsupialisation).

Marsupialisation is often carried out as a day case, so you will not have to stay in hospital overnight. It can be carried out under:

  • local anaesthetic, where the area is numbed so you cannot feel anything but you remain conscious throughout the procedure
  • general anaesthetic, where you are unconscious and cannot feel anything

Although complications after marsupialisation are rare, they can include:

  • infection
  • the abscess reoccurring
  • bleeding
  • pain – you may be given painkillers to ease any pain in the first 24 hours after the procedure

Bartholin’s cyst removal

In some cases, it may be necessary to remove the Bartholin’s cyst. This procedure is often considered to have the best long-term benefits, but requires an overnight stay in hospital.

There is also a higher risk of complications when the whole cyst is removed, including bleeding or blood collecting in the wound (haematoma).

Alternative procedures

These procedures are alternative ways of treating a Bartholin’s cyst, but are rarely used or are not widely available.

Silver nitrate gland ablation

Silver nitrate is a mixture of chemicals sometimes used in medicine to cauterise (burn) blood vessels to stop bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.

An incision is made in the skin of your vulva (your external sexual organs) and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the cavity (the empty space that is left after draining the fluid).

The silver nitrate causes the cyst cavity to form into a small, solid lump. After two or three days, the piece of silver nitrate and the cyst cavity are removed or they may fall off on their own.

It is possible for the silver nitrate to burn some of the skin of your vulva when it is first used. One small study reported that this occurs in 20% of women.

Carbon dioxide laser

A laser is used to create an opening in the skin of your vulva so that the cyst can be drained. The cyst can then be:

  • removed
  • destroyed using the laser
  • left attached but with a hole in it

Needle aspiration

During needle aspiration, a needle is used to drain the cyst.

Sometimes, this is combined with a procedure called alcohol sclerotherapy, where the cavity is then filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and then drained out.

Vaginal Rashes and Sores

Topic Overview

A rash in your vaginal area (vulva) may be caused by irritation of the skin from many sources, such as clothes rubbing against the skin. Rashes that occur without other symptoms are usually minor and often go away with home treatment.

Contact dermatitis

A common cause of a rash is contact with a substance that causes irritation or an allergic reaction (contact dermatitis). Soaps, detergents, shampoos, perfumes, or lotions can cause contact dermatitis. Often the rash from contact dermatitis is very itchy, but it is rarely serious. Changing your soap or detergent may be all you need to do to prevent this type of rash.

Other rashes in the vaginal area

Other conditions that may cause a rash in the vaginal area include:

  • Scabies, which is an itchy skin condition caused by tiny mites that burrow into the outer layers of the skin.
  • Pubic lice, which are small insects that live on humans and survive by feeding on blood.
  • Yeast infection (cutaneous candidiasis), which may cause a rash in the moist skin folds of the vaginal area.
  • Psoriasis, which causes raised red or white patches topped with silvery, scaling skin. The patches are most common on the knees, elbows, scalp, tailbone, and back, but may appear anywhere on the body (including the fingernails, palms, and soles of the feet).

Sores, blisters, or lumps in the vaginal area

Conditions that may cause a sore, blister, or lump include:

  • Genital herpes. Genital herpes is a viral infection that causes skin blisters and sores in the vaginal area.
  • Genital warts. Genital warts are a sexually transmitted infection (STI). They are caused by various types of human papillomavirus (HPV).
  • Bartholin gland cyst. Bartholin glands are two small glands located on each side of the opening of the vagina. These glands produce fluids that lubricate the opening to the vagina. If the opening to one of the glands becomes blocked, fluids may build up inside the gland, causing a painless lump called a Bartholin cyst. Bartholin cysts usually do not need treatment, but sometimes surgery may be needed to drain them. In some cases, one of the glands may become infected, causing an abscess, which may need to be drained.
  • Sexually transmitted infections (STIs). Sores, blisters, or ulcers, especially in the groin or vaginal area, may be the first symptom of several different STIs.
  • An infected hair shaft (folliculitis). A red, tender lump may form when skin bacteria cause an infection at the base of a hair shaft.

Definition & Overview

Cysts are pockets of tissue that form under the skin. These are closed and are filled with fluid. Although non-cancerous, they can cause discomfort, may be painful if they rupture, may get inflamed, and are very prone to infection.

Cysts form in the body due to many possible skin conditions; thus, they also come in many different types. These include:

  • Skin cysts – These are painless, skin-colored lumps that can appear anywhere on the body.

  • Sebaceous cysts – Also known as epidermoid cysts, these are benign cysts that form on the hair follicle and are commonly found on the chest, back, or genitals.

  • Cherry angioma – Also known as Campbell de Morgan’s spot, these are cherry-red colored bumps on the skin surface that occurs most commonly on the trunk of people aged 40 and older.

  • Dermatofibromas – Reddish or brownish round bumps that usually appear on the legs or arms. They may feel like hard lumps.

  • Folliculitis – Cysts formed due to inflamed hair follicles that most commonly occur on the face and scalp.

  • Keratoacanthoma – These cysts are caused by abnormal cell growth due to a past skin injury. They most commonly occur among people over age 60 and in body parts that have previously experienced sun damage.

  • Keratosis pilaris – These are white or red cysts that have a rough surface. They are most common during the winter months.

  • Lipomas – Lipomas are slow-growing, harmless, subcutaneous tumours that are made up of soft tissue, thus giving them a rubbery consistency. These are most common on the neck, shoulders, and trunk.

Cause of Condition

Cysts can be caused by several factors, such as:

  • Infection
  • Clogged oil glands, also known as sebaceous glands
  • A reaction to foreign objects attached to the skin, e.g. earrings
  • Scar tissue
  • Chemical irritation
  • Friction from tight clothing
  • Shaving
  • Abnormal cell growth
  • Minor skin injury
  • Sun damage from ultraviolet radiation
  • Skin dryness
  • Pregnancy and childbirth
  • Groups of cysts clustered together

Some ongoing health problems may also increase a person’s risk of getting cysts; these include:

  • Weakened immune system
  • Diabetes
  • Obesity

Some cysts, such as cherry angioma and dermatofibromas, have unknown causes.

Key Symptoms

Here are some key symptoms of the different types of cysts to help you determine whether you have a cyst and what type it is.

Skin cyst

  • Feels like peas under the skin
  • Grows slowly or does not grow at all
  • Painless
  • Has a smooth surface
  • Tends to roll when pressed

Sebaceous cyst

  • Round
  • May be skin-colored or may look darker
  • Becomes red and tender when infected
  • Can release a white discharge when squeezed or when they rupture

Dermatofibromas

  • A round growth that changes color from red to brown or purple
  • Tenderness
  • Pain
  • Itching
  • Creates a dimple when the growth is pinched

Folliculitis

  • Has a papule or pustule in the middle
  • Has a hair in the center
  • Several red bumps in body parts that have hair
  • Itchy skin

Keratoacanthomas

  • Thick growth
  • Dome-shaped bump around 1-3 inches in diameter
  • Have a crusted plug in the center

Who to See & Types of Treatments Available

If you have a cyst or any abnormal lump or bump under the skin, it helps to have a doctor conduct a checkup, regardless of whether the cyst causes pain or not. This is to make sure the cyst is safe and is not infected. Since most cysts go away on their own after a while, your primary care physician or internist would tell you whether treatment is necessary for your specific case.

If treatment is required, you will be referred to a dermatologist, a doctor specializing in diagnosing and treating problems of the skin.

You can also approach other health professionals depending on the type and location of cysts you have. For example, if you have a genital cyst, you can see an obstetrician-gynecologist for treatment.

Treatment also depends on the type of cyst you have:

  • Skin cysts. The treatment procedure will depend on whether the cyst is infected or not. If it is not infected, the cyst will simply be drained by piercing it and draining its contents. This will immediately reduce the size or completely get rid of the lump. However, there is a possibility of the cyst recurring. If a cyst is inflamed or infected, your doctor may inject a cortisone medication before shrinking it. If a cyst does not respond to the medication, it can be surgically removed.

  • Sebaceous cysts. To get rid of a sebaceous cyst, its sac, which contains the white discharge, has to be removed. If the discharge is squeezed out without removing the sac, the cyst is highly likely to recur. Sebaceous cysts can become infected; if this happens, your doctor will prescribe antibiotics to get rid of the infection before removing the cyst.

  • Cherry angioma. Most of the time, angioma cysts do not need treatment, but if they are prone to bleeding or if the appearance bothers you due to their location, they may be removed by electrocautery (burning and destroying the tissue) or the more common laser surgery. Both treatment options may leave behind a scar.

  • Dermatofibromas. These cysts are either frozen with liquid nitrogen and flattened or are surgically removed.

  • Folliculitis. The treatment of folliculitis will depend on what caused the infection in the first place; it can be treated with topical or oral antibiotics if there is bacterial infection or with an antifungal cream if the cause is a fungal infection. It is also important to avoid wearing tight clothing and shaving, and to clean the area often; these steps will help prevent the cyst from recurring.

  • Keratoacanthomas. These skin growths require treatment and removal since they are considered as a low-grade skin cancer. First, the growth is removed either through surgery, cryotherapy (freezing and removing) or curettage (burning and scraping off). Next, a cancer drug is then directly injected into the lesion of the growth.

  • Keratosis Pilaris. Keratosis pilaris does not medically require treatment, but most people who have these growths have it removed usually due to cosmetic reasons. To treat this cyst, the area of growth should first be intensively moisturized; your doctor can prescribe the necessary medication, such as AmLactin or LadHydrin creams, which can be applied repeatedly every day. Next, the growth has to be gradually exfoliated; you can do this every day by rubbing it with a brush or washcloth when taking a bath.

  • Lipomas. Lipomas do not require treatment, unless they compress the nerves, which can cause some pain. Some people also ask for treatment for cosmetic reasons, whereas some doctors prescribe standard excision if there is no accurate diagnosis as to what caused the cyst to form. If the growth is too large, lipectomy or the removal assisted by liposuction, may be necessary; this can cause minimal scarring on the affected area.

  • Warvi W, Gates O. (1943). “Epithelial cysts and cystic tumours of the skin.” The American Journal of Pathology.

  • Stevens D, Bisno A, Chambers H, Everett ED, Dellinger P, et al. “Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections.” Clinical Infectious Diseases, Oxford Journals.
  • Luba M, Bangs S, Mohler A, Stulberg D. (2003). “Common Benign Skin Tumours.” American Family Physician.
  • Christenson L, Patterson J, Davis D. (2000). “Surgical pearl: Use of the cutaneous punch for the removal of lipomas.” Journal of the American Academy of Dermatology.
  • Lanigan SW, Robinson TW. (1987). “Cryotherapy for dermatofibromas.” Clin Exp Dermatol.
  • Schwartz RA. (1994). Keratoacanthoma.” Journal of the American Academy of Dermatology.

What causes a hard lump under the skin?

Causes of a hard lump under the skin can include:

A cyst is a closed pocket of tissue that contains fluid or debris. Cysts can form anywhere on the body. Their texture varies depending on the material that has become trapped inside the pocket.

A cyst can develop due to a clogged oil gland or hair follicle. Cysts feel like soft blisters when they are close to the skin’s surface, but they can feel like hard lumps when they develop deeper beneath the skin.

A hard cyst near to the surface of the skin usually contains trapped dead skin cells or proteins. Types of cyst include:

  • ganglion cysts, which are common on the wrists and hands
  • synovial cysts, which develop on the spine
  • pilar cysts, which appear on the scalp
  • mucous cysts, which can form on the feet, toes, or inside of the mouth

Cysts rarely require treatment, and they will often stop growing and then disappear on their own. In some cases, a blackhead can develop near the center of a cyst. When this happens, a cyst may burst open, releasing white or yellow discharge.

An infected cyst that is red, swollen, or painful may require medical treatment, such as:

  • antibiotics
  • needle aspiration
  • corticosteroid injections
  • a surgical procedure to remove the cyst

Dermatofibroma

Dermatofibromas are hard brown or red lumps under the skin. They usually develop on exposed areas of skin, such as the legs, arms, and back. Dermatofibromas do not develop into cancer.

In general, people who have dermatofibromas do not experience other symptoms. However, in some cases, the dermatofibroma may feel itchy, irritated, or tender to the touch.

Dermatofibromas develop when excess cells collect in the thickest layer of the skin, which is called the dermis.

The exact cause of dermatofibromas remains unclear, but potential causes include:

  • trauma or injury to the skin
  • insect or spider bites
  • splinters

Dermatofibromas do not generally require treatment, but they tend to stay on the skin for the rest of the person’s life.

People can ask a doctor to remove a dermatofibroma surgically if it is unsightly or in a bothersome area.

The other treatment options will only remove part of the dermatofibroma. They include:

  • freezing it with liquid nitrogen
  • corticosteroid injections
  • shaving off the top layers of the growth
  • removing its center

Swollen lymph node

Share on PinterestA cold or viral infection can cause swollen lymph nodes.

Lymph nodes are small glands that filter harmful substances from lymph fluid, which is the clear liquid that travels through lymphatic vessels.

These small, bean-shaped glands are an essential component of the immune system. They produce and store white blood cells that destroy disease-causing pathogens and waste.

Sometimes, lymph nodes swell in response to bacterial or viral infections. They may feel hard and painful.

Swollen lymph nodes usually occur in the head, neck, armpits, or groin.

Several factors can cause swollen lymph nodes, such as:

  • a cold or another viral infection
  • bacterial infections
  • tooth infections
  • ear infections
  • medical conditions that affect the immune system, such as rheumatoid arthritis or lupus

People who have swollen lymph nodes due to infection are likely to experience other symptoms, such as:

  • a runny nose
  • a cough
  • a sore throat
  • fever
  • headaches
  • fatigue

In most cases, swollen lymph nodes will heal on their own without medical treatment. If they do not, the focus of treatment should be to address the underlying cause, which is usually an infection.

A swollen lymph node that feels hard, rubbery, or immovable may indicate a more serious medical condition.

Certain cancers, such as lymphoma, leukemia, and breast cancer, can affect the lymph nodes. Anyone concerned about swollen lymph nodes should speak to a doctor.

Lipomas

A lipoma is a benign tumor comprising fatty tissue. These noncancerous lumps develop just below the skin, and they appear pale or colorless. Lipomas usually feel soft and easily moveable.

In general, lipomas do not cause symptoms. However, a lipoma that involves multiple blood vessels or nerves may feel tender or painful.

The exact cause of lipomas remains unknown. Some genetic conditions, such as Gardner’s syndrome, can increase a person’s likelihood of developing a lipoma.

Lipomas do not require medical treatment unless they are painful, bothersome, or interfering with a person’s ability to function normally.

Treatment options for lipomas include:

  • liposuction
  • drainage
  • steroid injections
  • surgical excision

Fibroadenoma

A fibroadenoma is a benign breast tumor that consists of fibrous tissues and gland tissues.

According to the American Cancer Society, fibroadenomas most commonly occur in women in their 20s and 30s, though they can happen at any age. Fibroadenomas usually feel firm but movable.

Fibroadenomas can develop as a result of high levels of estrogen. They may grow due to increases in hormone levels during pregnancy. In contrast, fibroadenomas can shrink during menopause.

Fibroadenomas that are not painful or growing will not require medical treatment. However, people should monitor themselves for any changes in the size or appearance of a fibroadenoma.

A doctor may recommend removing a fibroadenoma if:

  • it causes pain
  • the person experiences changes in the shape or appearance of their breast
  • the person has a family history of breast cancer

PMC

DISCUSSION

The granular cell tumor (GCT) of hand is very rare. The incidence of the GCT of hand is less than 0.1%. The origin of GCT is an ongoing debate and includes muscle, fibroblast, histiocyte, neural crest, and nerve sheath. The cell of origin is now accepted to be the schwann cell due to strong S-100 protein expression on immunohistochemistry and granular cells contains lysosomal vacuoles with myelin figures, prominent basal lamina, and intracytoplasmic filaments ultrastructurally.

GCT may occur at any age, but common in the third to fifth decade of life. Two-third of cases are reported in women and in black population. The common sites are the tongue, skin, and subcutaneous tissue. It can also been found in the soft tissue, nerve, breast, scalp, abdominal wall, head and neck, back, extremities, lymphnode, mediastinum, soft palate, orbit, salivary glands, respiratory tract, vulva, gastrointestinal tract, brain. GCT commonly presents as an asymptomatic slow growing, solitary, painless nodule that may have either smooth or hyperkeratotic overlying skin. The lesions are usually less than 3.0 cm in size and may undergo partial regression. Multiple GCTs have only been reported in less than 10% of cases, especially in children and teenagers. Multiple GCTs are reported in association with neurofibromatosis, Watson’s syndrome, Lentiginosis profusa, Noonan syndrome, facial and ocular alterations, cardiovascular abnormalities, muscle and bones malformations, and neurologic deficits. Clinically this may give an impression of malignancy; however a careful microscopic evaluation with attention to size of the lesion should resolve the question. Very rarely, multifocal GCTs are reported in association with malignancy. Squamous carcinoma of the esophagus, adenocarcinoma of the prostate, and small cell lung cancer are among the reported cases of this association. The common preoperative clinical diagnoses of GCT are dermatofibroma, fibromatosis, keloid or lipoma.

GCT is sharply circumscribed to an ill-defined mass with hard consistency and yellowish cut surface. Microscopic features of benign GCT are remarkably uniform regardless of the site. Few reports describe the cytologic features of GCT. The GCT of hand is probably not diagnosed by cytology in all previously described 17 cases. The cytological findings of GCT in our case are identical to those described by previous authors. A granular cell is large, round to polygonal with abundant eosinophilic, finely granular cytoplasm with indistinct cell borders, eccentrically located oval to round nuclei with fine nuclear chromatin, and occasional small or inconspicuous nucleoli. Pustulo-ovoid bodies of Milian are larger granules surrounded by a clear halo. They appear to represent the heterogeneity of the lysosomes, giving the appearance of large granules that have partially detached from the adjacent cytoplasm. The granularity of the cytoplasm is caused by a massive accumulation of lysosomes which gives positive reaction to CD68 and periodic acid–Schiff stain. However, CD68 reaction is negative in our case. Cytologic atypia may occur, but mitoses are rare. Liu et al. cautioned that occasional nuclear polymorphisms and prominent nucleoli were compatible with benignancy. In the present case, the tumor cells were positive for S-100 protein and NSE, which supports the schwann cell differentiation. Vimentin is usually expressed in GCTs. The GCT is associated with downward proliferation of adjacent squamous epithelium which mimics squamous cell carcinoma. Most GCTs are benign. Malignant GCTs comprise fewer than 2% of all GCTs. Malignant GCTs are usually large and deep seated. Fanburg-Smith et al. classified atypical, malignant, and benign granular cell tumors on the basis of six histologic criteria: Necrosis, spindling, vesicular nuclei with large nucleoli, increased mitotic activity (>2 mitoses/10 high power fields at ×200 magnification), high nuclear to cytoplasmic ratio, and pleomorphism. Neoplasms that met three or more of these criteria were classified as histologically malignant, those that met one or two criteria were classified as atypical, and those that displayed only focal pleomorphism, but fulfilled none of the other criteria, were classified as benign.

In our case reactive granular cell histiocytic reaction closely mimics GCT as the patient has past history of thorn injury. The granular cells in reactive lesions tend to be associated with inflammatory elements and areas of necrosis which are not seen in our case. The inflammatory cells mimicking granular cells are macrophages, foam cells, fat necrosis, and numerous histiocytes. Macrophages show ingested debris with ill-defined cytoplasmic border, eccentrically located irregular to reniform in shaped nucleus with small nucleolus. Foam cells of xanthoma are large pale cells with foamy cytoplasm and take up fat stains. The differential diagnosis of GCT include rhabdonyoma, rhabdomyosarcoma, alveolar soft part sarcoma, hibernoma, fibroxanthoma, fibrous histiocytoma, dermatofibroma, dermatofibrosarcoma protuberans, schwannoma, neurofibroma, paraganglioma, oncocytic neoplasms, leiomyosarcoma, melanoma, and metastatic renal cell carcinoma. Rhabdomyosarcoma reveals characteristic rhabdomyoblasts with positivity for muscle markers such as desmin and myogenin, whereas the granular cell tumor shows positivity for the S-100 protein. Alveolar soft part sarcoma shows marked nuclear pleomorphism and prominent nucleoli, with an alveolar arrangement. Unlike hibernoma, the cells of the granular cell tumor do not have vacuolated cytoplasm. Clinically, paraganglioma does not occur as a primary soft tissue tumor in the extremities. Paraganglioma shows moderate nuclear pleomorphism, occasionally follicle-like pattern with positivity for chromogranin and synaptophysin. Epithelioid sarcoma displays vesicular nuclei with large nucleoli in the background of necrosis and inflammatory cells. Epithelioid sarcoma shows positivity for epithelial markers such as cytokeratins and EMA. Metastatic renal cell carcinoma is negative for the S-100 protein.

Surgical excision with safe margins is recommended due to ill-defined margins and risk of recurrence. This emphasizes the need of recognizing this lesion on FNAC, so that an adequate curative resection may be planned. Further follow-up is necessary due to the possibility of recurrence and malignant transformation. The malignant variant is aggressive and metastasized to bones, lungs, liver, and regional lymphnodes. Wide en bloc excision is recommended for malignant lesions. Chemotherapy, alone or in association with radiotherapy, is not given unless the tumor is malignant.

As we age, the smooth skin of childhood gives way to all sorts of mysterious lumps and bumps. In a high-UV environment like Australia, we need to be very alert to the possibility of skin cancers. But most of the skin lumps we develop will be benign. Here are some of the most common, and how to tell them apart.

Moles

Moles, or naevi, are the most common skin lesions. They are formed by a cluster of melanocytes, the skin’s pigment-producing cells. They can be brown, black, pink, the same colour as the surrounding skin, or even blue if the melanocytes are clustered deep in the dermal (inner) layer of the skin. Most moles are flat but they can also be raised.

While some people have moles at birth, they usually begin to appear during childhood and keep developing through to your 40s, when they start to slowly disappear again. The number of moles you have is partly controlled by genetics, but is also influenced by your environment. Lots of sun exposure leads to more moles, and so can using certain medications, such as those that suppress your immune system.

Moles themselves are harmless, but around 25% of melanomas arise in an existing mole. Many more look like moles in their early stages.

It’s a good idea to get any new or changing mole checked by a doctor, who will usually examine the mole with a dermoscope, a hand-held microscope that uses polarised light to see just under the skin surface. If the lesion is asymmetrical, multi-coloured or has other signs of melanoma, the doctor will excise it for further testing.

A dermoscope helps your doctor see if your mole has hidden melanoma signs, or if it’s nothing to worry about. UQ

Having many moles is the strongest predictor of a high melanoma risk, so people with many moles are often advised to have regular skin checks with a dermatologist. For the rest of us, self-examinations are recommended.

Seborrhoeic keratoses

Seborrhoeic keratoses, sometimes inelegantly called senile warts or barnacles, are another common benign skin lesion. These are considered part of the normal skin ageing process.

These wart-like growths can begin to appear in your 30s and 40s. By the age of 60 around 90% of people will have at least one seborrhoeic keratosis. They can erupt suddenly after a sunburn or a bout of dermatitis, or gradually appear for no discernible reason.

If many itchy seborrhoeic keratoses erupt suddenly, it is occasionally a sign of an internal cancer. Very rarely, basal or squamous cell carcinomas arise within a pre-existing seborrhoeic keratosis. Seborrhoeic keratoses themselves are harmless, but can be prolific – some people have hundreds – and they increase in number as the years go by.

Some people develop lots of seborrhoeic keratoses, both big and small. UQ

Seborrhoeic keratoses can be flat or raised, and often look as though they’ve been glued onto the skin instead of growing out of it. Their colour ranges from pale yellow to black. They can be waxy, warty or scaly, and anywhere between 1mm and several centimetres across.

Those that are dark and large can look alarming, but when seen under a dermoscope they usually have a characteristic brain-like or banksia-like appearance and are easily distinguished from skin cancers. If in doubt, your doctor will take a biopsy to investigate further, since a melanoma can occasionally simulate a seborrhoeic keratosis.

Seborrhoeic keratoses can be annoying if they snag on clothes or get in the way of your razor, and some people find them unsightly. In these cases they can be removed by freezing, cutting them off, burning, laser surgery, chemical peels or excision with scalpel or scissors.

This lesion looks alarming at first glance, but under a dermoscope it’s obvious by the banksia-like appearance that it’s a benign seborrhoeic keratosis. UQ

Cysts

A cyst is a round lesion made of a capsule filled with keratin (the structural material that makes up the outer layer of our skin), sebum (the oil from our skin), fluid or pus-like material. Firm or squishy to the touch, they are totally benign. At least 20% of adults will have a cyst of some sort in their life.

Sometimes cysts form when injured skin gets tucked in to form a pocket and the maturing and dying skin cells build up inside it. Other cysts are formed when epidermal cells, normally found on the surface of the skin, proliferate in the deeper dermis and fill up in a similar way.

Some cysts form when a hair follicle, sweat duct or mucous gland becomes blocked and fluid builds up behind the blockage. Ganglion cysts form when fluid from nearby joints leaks into a capsule under the skin. Several genes can make you more susceptible to forming cysts of various sorts.

An inflamed epidermal inclusion cyst. Steven Fruitsmaak/Wikimedia Commons

The material inside a cyst can range from watery to soft-cheese-like, and can be odourless or smelly. A central pore may be visible on the cyst, but beware of trying to pop and drain the cyst yourself – it can become infected if you don’t clean it adequately.

Usually the only way to get rid of a cyst permanently is to surgically remove its encapsulating wall. If it is only drained of fluid, it will just fill up again.

Fortunately, a dermatologist can usually remove a cyst in a short procedure with a little local anaesthetic. This is demonstrated in the weirdly popular videos of Dr Pimple Popper (which, by the way, you might not want to watch at lunch).

Haemangiomas

Haemangiomas are another benign, usually painless skin lesion, formed from an excessive growth of blood vessels in the skin. They are usually firm lumps and can present as cherry angiomas, venous lakes or spider angiomas. Depending on how deep in the skin they are, they can be red, purple or even deep blue.

The author’s collection of cherry angiomas. Glen Wimberley/UQ

Cherry angiomas are round or oval, sharply defined, bright red bumps, usually less than half a centimetre wide. If found on the lip, they are called venous lakes.

Spider angiomas also have a tiny central red lump, but with red lines (capillaries) wriggling outwards like the legs of a spider. They usually appear on the face and upper body.

If many spider angiomas suddenly appear, it can be a sign of high oestrogen or poor liver function, but, as a rule, isolated spider angiomas are not a cause for worry.

Rarely, angiomas mimic amelanotic (non-pigmented) nodular melanomas. These need to be excised for further testing.

The rest don’t require treatment except for cosmetic reasons. In that case, the angioma can be frozen with liquid nitrogen, burnt off with electrosurgery, or treated with lasers.

Dermatofibromas

Dermatofibromas are firm small nodules, which are sometimes itchy and might be mistaken for an insect bite. In fact, most probably they also evolve from some types of insect bites.

They are usually 1cm across or smaller, seem to be in the surface layer of the skin and, if you pinch one, a dimple will appear in it. On pale skin, they range from pink to light brown, and on darker skin from dark brown to black, and can be paler in the middle.

Dermatofibroma. Glen Wimberley/UQ

They are caused by a benign proliferation of fibroblast cells (the main cells in connective tissue), perhaps in response to a mild skin injury, but it’s not clear why this happens. The immune system seems to keep them in check, as several new dermatofibromas can appear when a person’s immune system is suppressed.

Like seborrhoeic keratoses, dermatofibromas are harmless but can be annoying. In this case, they are removed by simple surgical excision. If they are ulcerated, have recently become bigger or are unusually coloured, your doctor will excise them to check they aren’t melanomas or basal cell carcinomas.

Lipoma

Lipomas are not, strictly speaking, a skin lesion at all. Often appearing similar to cysts, lipomas are actually slow-growing tumours of fat cells surrounded by a fibrous capsule. They don’t actually grow in the skin, but in the subcutaneous layer underneath.

Two large lipomas on the back. James Heilman, MD

Like cysts, they are very common and not malignant. Many people with lipomas have a family history of lipomas, so there’s probably a genetic cause. Some lipomas might arise after a blunt injury to the site, but the mechanism causing that is not well understood.

The egg or dome-shaped lipoma usually feels rubbery and moves around easily under the skin. This makes them easy to diagnose clinically, though doctors sometimes use a deep skin biopsy to be sure.

Most lipomas are not painful to touch, but they can grow as big as 10cm across and restrict movement of nearby muscles or joints. If that’s the case, or you are bothered by its appearance, lipoma can be treated by surgically removing the whole tumour, liposuction to drain the inside, or simple squeeze technique, where a doctor makes a small incision in the skin and squeezes out the fat tissue.

When to get it checked

Any lump, bump or lesion on your skin is worth showing to a doctor if it’s worrying you, but there are some red flags that should prompt you to make the appointment sooner rather than later.

A newly appeared mole or an existing mole that starts growing or changing colour should be checked. If the lesion bleeds very easily – at a touch – get it looked at as soon as possible. Painful lumps are another sign all is not right.

Finding a new lump or bump on your body would give most of us pause. After all, a lump can, in rare cases, mean cancer. But not every bump or lump should cause concern or worry.

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The good news is that a majority of these lumps are harmless and not a cause for concern. A number of skin or medical conditions can cause lumps and bumps to appear on the surface or just below the skin.

When not to worry

Lumps that are not a cause for concern have some distinctive characteristics.

One major marker is if you can connect the lump’s appearance to a specific trauma or activity, says orthopedic surgeon Nathan W. Mesko, MD. Athletes of all levels experience the occasional bump as a result of exercise, training, competition or other physical activity.

In that case, we recommend you follow the basic RICE method of rest, ice, compression and elevation,” Dr. Mesko says. “If, over time, the lump or swelling improves, that’s a reassuring sign that it is harmless and nothing to worry about.”

Not-so-serious lumps usually are:

  • Soft
  • Mobile, meaning it moves and changes form when you touch it
  • Located in the superficial or fat layer of skin
  • Grow large and painful with activity, and diminish in size with rest

One of the most common conditions that cause lumps, bumps or swelling are cysts. Some common cysts include Baker’s cysts, a fluid-filled bulge that forms behind the knee and ganglion cysts, rounded lumps filled with a jelly-like fluid that develop along tendons and joints.

Other conditions that can cause swelling include tendonitis, enlarged lymph nodes when accompanied by inflammation or infection, or rheumatoid arthritis.

When more investigation is needed

In rare cases, an unexplained lump, bump or swelling can be a sign of a more serious issue beneath the skin.

Bumps that are cancerous are typically large, hard, painless to the touch and appear spontaneously. The mass will grow in size steadily over the weeks and months. Cancerous lumps that can be felt from the outside of your body can appear in the breast, testicle, or neck, but also in the arms and legs.

One type of cancerous lump that can form almost anywhere in the body is called adult soft tissue sarcoma. The soft tissues of the body include the muscles, tendons (the bands of fiber that connect muscles to bones), fat, blood vessels, lymph vessels, nerves and the tissues around joints.

Most frequently, though, adult soft tissue sarcoma develops in the legs, arms, chest or the area behind the abdomen called the retroperitoneum, says oncologist Dale Shepard, MD, PhD.

“Adult soft tissue sarcoma is a disease in which malignant cells form in the soft tissues of the body,” he says. “In the early stages, it rarely causes symptoms because the tumors often are located deep in the tissue.”

Soft tissue sarcomas can grow to be quite large before causing symptoms because they often are embedded deep in the body, Dr. Shepard says.

Most commonly, soft tissue sarcomas feel like masses or bumps, which may be painful. If the tumor is in the abdomen, it may produce nausea or a sensation of fullness as well as pain, he says.

Adult soft tissue sarcoma is rare. Among adults, they represent less than 1 percent of all cancers, Dr. Shepard says.

It’s important to talk with your doctor about any lumps that are larger than two inches (about the size of a golf ball), grow larger, or are painful regardless of their location.

“Tell your doctor about new lumps or other symptoms that cannot be explained or that don’t go away in a few weeks,” Dr. Shepard says.

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

Sarcomas can start in any part of the body. The types of symptoms that people have from a sarcoma depend on where it starts. People with sarcoma may experience the following symptoms or signs. Sometimes, people with sarcoma do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

STS rarely causes symptoms in the early stages. The first sign of a sarcoma in an arm, leg, or torso may be a painless lump or swelling. Most lumps are not sarcoma. The most common soft-tissue lumps are lipomas. Lipomas are made of fat cells and are not cancer. Lipomas have often been there for many years and rarely change in size. In the uterus, benign tumors called fibroids, or leiomyomas, far outnumber sarcomas.

However, it’s important to talk with your doctor about any lumps that are larger than 2 inches (5 centimeters), grow larger, or are painful, regardless of their location. People with a sarcoma that starts in the abdomen may not have any symptoms, or they may have pain or a sense of fullness.

Because sarcoma can develop in flexible, elastic tissues or deep spaces in the body, the tumor can often push normal tissue out of its way as it grows. Therefore, a sarcoma may grow quite large before it causes symptoms. Eventually, it may cause pain as the growing tumor begins to press against nerves and muscles.

Sarcomas that arise in other parts of the body may cause other symptoms or signs. For example, sarcomas that arise in the uterus can cause uterine bleeding or an increase in the size of the uterus. Tumors that start in the heart or a lung may cause breathing problems or pain in the chest.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If a sarcoma is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

What’s Causing This Bump on My Forehead, and Should I Be Concerned?

Most bumps that appear on the forehead are benign if there are no other serious symptoms present. These bumps can form for a variety of reasons.

Knowing the cause and whether it represents a potential medical emergency should help you make an informed health care decision.

The following are some of the more common causes of bumps on the forehead.

Trauma

Whether it’s from a fall, a collision on the soccer field, a car accident, or other high-impact contact, trauma is a leading cause of hematomas. A goose egg is essentially just a bruise on the forehead. These bumps often turn black and blue after a day or two.

When the tiny blood vessels under the skin are injured, blood leaks out into the surrounding tissue, causing the swelling that forms a bump or knot on the head.

A small bump with no other symptoms should be watched for a few days.

The presence of other symptoms or a bump that’s more than a couple of inches across should be examined in an emergency room.

A bump that doesn’t get smaller within a few days should also be checked out by a doctor.

Usually, hematomas disappear on their own and require no treatment. Icing a bump immediately after an injury may help keep the swelling to a minimum.

Cyst

A cyst is a fluid-filled sac that forms just underneath the skin. It’s usually soft to the touch and appears whitish or yellowish. There are several types of cysts that can appear on the forehead.

One of the more common cysts is formed when keratin cells move deeper into your skin and form a sac. Keratin is a protein in the skin. Normally keratin cells move up to the surface and die. When they move the other direction, they can cluster in a cyst that swells as it grows.

You should never try to pop a cyst. The risk of infection is too great. Instead, press a warm, wet washcloth to your forehead. You can also see a dermatologist for topical creams that may help the cyst heal.

Osteoma

A benign little outgrowth of bone, called an osteoma, can form a forehead bump. Typically, an osteoma grows slowly and has no other symptoms.

An osteoma can usually be left alone. But if the growth is bothersome from an appearance standpoint or is causing some symptoms (such as vision or hearing problems) due to its location, treatment may be appropriate.

The main treatment for an osteoma is surgery. A relatively new procedure, called an endoscopic endonasal approach (EEA), relies on the natural openings in the sinus and nasal cavities.

These allow a surgeon to make an incision in the base of the skull and guide the small, flexible instruments to the location of the osteoma. The osteoma is then removed through the nose. EEA means no disfigurement or scarring of the face and a faster recovery time.

A lipoma is a growth of fatty tissue that can develop under the skin, causing a soft, pliable lump to form on the forehead. Lipomas also tend to form on the neck, shoulders, arms, back, thighs, and abdomen.

A lipoma is usually less than 2 inches in diameter, but it can grow. Lipomas are usually benign, but they can be painful if they’re near any major nerves.

Skull malformation

If you’ve had a facial fracture or other skull injury, it’s possible that a lump could form on your forehead as the bones heal and fuse together.

Occasionally when surgery is done to repair a fracture, improper bone healing can still occur. This could mean a second surgery is needed to help make sure the bones heal properly.

Sinus infection

In rare cases, a serious sinus infection (sinusitis) can lead to swelling around the forehead and eyes. Usually though, sinusitis causes pain in and around the sinus cavity, but no visible signs of inflammation.

Bites or stings

An insect bite or sting can cause a small red lump to form on the forehead. These bumps are usually unmistakable and typically require no treatment. Try leaving a bite alone and taking an antihistamine to help reduce swelling and itching.

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