Lumps and Bumps - Do I Have Cancer?

I often see patients for concerns regarding a bump or a lump that is growing under the skin.  However, while serious illness - namely cancer - CAN be the cause of a lump, many don't realize that the cause is most often something harmless. 

This blog will outline the most common cause for non cancerous bumps and what is worth worrying about.

The Lipoma

What is a Lipoma? Lipomas are fatty growths that are found beneath the skin, within the fatty layer of tissue. From a tissue standpoint, lipomas actually look like normal fat. They are abnormal, however, in the fact that they grow in a whorled ball within the layer of fat. This makes lipomas palpable (able to be felt).

Identifying a Lipoma: Many times lipomas are hidden within the fatty layers, especially when there is an abundance of fat. It is not uncommon for people to feel them after a period of weight loss when they are "revealed." Lipomas can occur anywhere there is fat, which is pretty much everywhere.  Typically, they have a rubbery consistency and are quite mobile under the skin.  Lipomas are not tender to the touch.  Though this is rare, lipomas can be cancerous. 

When to see a doctor about a Lipoma: If the lipoma comes up quickly, is tender, or lacks a uniform rubbery consistency, it should be removed.  Aside from this, lipomas do not need to be removed unless they are cosmetically unacceptable, irritate a nerve causing tenderness, or are on a place where they hinder function (such as on the buttocks preventing sitting comfortably or on the back preventing laying comfortably).  Small lipomas can be removed in the office under local anesthesia and a  couple of stitches are placed.  If larger, it may require removal in the operating room under sedation or general anesthesia.  People can have a tendency for developing lipomas and if there is one there are (or may be) others.

The Sebaceous Cyst

What is a Sebaceous Cyst? Sebaceous cysts are caused by plugged glands on our skin. Sebaceous glands make that sticky, oily substance on our skin. This is the reason we need soap to clean our skin. These glands can, on occasion, become plugged. If this happens and the plug is not relieved, the gland will continue to make sebaceous matter. The gland balloons out, filled with the dense matter that comes to have the consistency of cheese. The wall becomes tough and thickened with time, enclosing the sebaceous matter. 

Identifying a Sebaceous Cyst: Eventually, a bump is felt under the skin. Typically, sebaceous cysts are somewhat mobile and exist just below the skin. They are often found where we have the most sebaceous glands: the scalp, the back and the chest. It is not unusual for these cysts to wax and wan in size. Sometimes the pore can be seen in the skin atop the cyst and sometimes sebaceous matter can be expressed through this pore. It is usually white/gray, has a thick consistency and has a particular smell. 

When to see a doctor for a Sebaceous Cyst: Most often I do not bother sebaceous cysts unless they bother the patient. That is, if they become infected, exist in an inopportune place or are cosmetically unacceptable, they can be removed. Sebaceous cysts can be removed in the office under local anesthesia with a couple of stitches placed.

Lymph Nodes

What is a Lymph Node? Lymph nodes are the crossroads of our immune system, offering regional protection from invasion in our body.  Our immune system channels throughout our body that come together in these

Identifying a Lymph Node: When we have an infection or other source of inflammation, the immune system mounts a response and white blood cells with the code to fight off the trouble congregate in the lymph nodes.  As such, they swell.  These such enlarged lymph nodes are tender to the touch and mobile.  Obviously, with these "reactive" lymph nodes a source is identified such as a cold, sore throat, skin infection or injury. 

When to see a doctor about an enlarged Lymph Node: Enlarged lymph nodes on the back of the neck are often associated with an inflammatory condition of the scalp like dandruff or seborrhea. Swollen lymph nodes in the groin without an obvious source should raise concern for a sexually transmitted disease. Cancer, discussed next, can also cause enlarged lymph nodes that have a different characteristic.

Cancer

Cancer can cause a lump either primarily or via metastasis (spread from a primary source). In the case of lymphoma, cancer affects the lymph nodes directly.  Single or multiple enlarged nodes can be present with lymphoma. Thought they can be located anywhere, they are most commonly seen where lymph nodes are most common.  In the case of metastasis, a primary cancer spreads along the lymph channels and grows within the lymph node. Cancerous lymph nodes are hard, often described as "woody." They are fixed, immobile and often irregular in their consistency.

When Should I See a Doctor?

While most bumps under the skin are harmless, the following should cause concern and prompt a visit to the doctor:

• enlarged lymph nodes with no associated cause (infection or injury)
• a bump in the breast
• a sebaceous cyst that looks infected
• a bump that has the consistency of a lipoma but that is rapidly enlarging and painful
• a bump that is hard, immobile and irregular

Photo Credit: malloreigh, samuel_belknap, rockbadger, *scott

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