Lumps and Bumps

Lipoma Sebaceous Dermoid cyst Abscess Hemangioma Neurofib

cyst (strawberry
naevi)
Definition Tumor of fat A closed a cystic collection of a benign self a benign
cells sac filled teratoma that pus (dead involuting sheath tu
with sebum contains neutrophils) tumour of the perip
found just developmentally that has vascular nervous
below the mature skin accumulated endothelial
skin complete with in a cavity cells
hair follicles formed by
and sweat an
glands, infectious
sometimes process or
luxuriant other
clumps of long foreign
hair, and often materials
pockets of
sebum, blood,
fat, bone, nails,
teeth, eyes,
cartilage, and
thyroid tissue
Position Anywhere with Found in Midline of Anywhere Any part of Anywhe
fat hairy parts trunk, neck, and body subcutan
of body face tissue an
Skin color Normal, but Normal Normal Red Bright or dark Normal o
slightly red hyperpig
stretched with
transparent
appearance
Tenderness None Tender if None Yes None None
infected
(Cock’s
peculiar
tumor à
scalp)
Temperature Normal Normal Normal Warm Normal Normal
unless
inflamed
Shape Spherical, Spherical Spherical Spherical Protrudes Fusiform
discoid, or from skin axis alon
hemispherical surface; length of
pedunculated
Size Any size Few mm to 1-2 cm Any 1-10 cm < few cm
(diameter) 4-5 cm
Surface Smooth, Smooth Smooth Smooth; Irregular Smooth
bosselated tense
Edge Irregular curves Well Well defined Not Well defined Well def
defined palpable
Composition Liquid or solid; Fluctuant Fluctuant; Hard & Compressible; Firm rub
transilluminates; (+/-); no transilluminates solid with non-pulsatile dull to
no fluid thrill; fluid thrill; (if there is clear pus; percussio
dull to dull to fluid); fluid fluctuant;
percussion; non- percussion; thrill; dull to dull to
pulsatile non- percussion; non- percussion;
pulsatile pulsatile non-
reducible
Relations Mobile in all Fixed to Lie deep to Attached to Freely mobile Mobile a
directions skin; small skin; not skin; deep over deep moves fr
(moderately) punctum attached to fixation tissue right ang
(diagnostic) underlying depends on course o
structures size
Lymph Regional lymph Not Not enlarged Enlarged & Not enlarged Not enla
drainage nodes not enlarged tender
enlarged

Management:
Lipoma:
 Reassure patient that it is benign
 Excision – for cosmesis if desired
Sebaceous cyst:
 Reassure patient that it is benign
 Incision and removal of capsule
Dermoid cyst:
 Reassure patient that it is benign
 CT scan to rule out communication with intracranial dermoid or
meninges prior to excision
Abscess:
 Incision & drainage
 Antibiotic coverage
Haemangioma:
 May disappear spontaneously
 Diathermy coagulation
 Application of CO2
 Excision and grafting
Neurofibroma:
 Reassure patient that it is benign
 Can be removed by ennucleation or resection with suture of divided
nerve (if small in number)