Moles, Cysts & Lipoma
Some lumps and bumps are not dangerous but they can grow and depending on the location, can be troublesome.
Moles can be on areas of the face that gets traumatised with shaving for males. Sometimes, moles can change in appearance, and appear “dysplastic” hence the need for excision and further testing.
Management of Moles
Most moles are harmless, but if biopsy is required, it can be by either shaving some skin off at the location, or by excision.
In areas such as noses where skin closure is tight, if complete excision is not required, the mole can be shaved for diagnosis and to flatten its appearance. If it regrows, a decision can be made in the future regarding complete excision.
For the rest of the body, moles are usually excised with minimum margins.
Laser treatment is similar to shaving, but there is no specimen to test. Freezing moles are less effective for deeper moles, because the freeze required to achieve annihilation of the mole may create an ulcer that heals with a scar worse than the original mole.
Cysts are classified as epidermal pilar (scalp) or sebaceous in nature. True sebaceous cysts (otherwise known as steatocystoma contain sebum) are comparitively rare.
Originate in the top layer of the skin and contain keratin. The scalp, ears, back, face, and upper arm, are common sites of epidermoid cysts, though they may occur anywhere on the body except the palms of the hands and soles of the feet. In males a common place for them to develop is the scrotum or the chest. They are more common in hairier areas. A hair follicle has a small duct opening onto the surface of the skin, and if the duct becomes plugged with sticky material, the secretions from the cyst gradually build up and cause it to expand.
In cases of long duration they could result in hair loss on the skin surface immediately above the cyst. They are smooth to the touch, vary in size, and are generally round in shape.
About 90% of pilar cysts occur on the scalp, with the remaining sometimes occurring on the face, trunk and extremities. Pilar cysts are significantly more common in females, and can be genetically inherited. In many cases, multiple pilar cysts appear at once.
Management of cysts
Sebaceous cysts generally do not require medical treatment. However, if they continue to grow, they may become unsightly, painful, infected, or all of the above.
An infected cyst would require antibiotics. If it is unresponsive to antibiotics, then the cyst would need to be incised to discharge the pus.
At that stage, it would not be possible to excise the entire cyst as when infected it can be hard trace the true boundaries of the cyst. Sometimes, a marginal area around the cyst is removed in an attempt to compensate for inflammation.
With surgery, a cyst can usually be excised in its entiret (which is the sac and its contents).
Previous infection and scarred areas may lead to rupture during excision and removal. A completely removed cyst will not recur, though if the patient has a predisposition to cyst formation, further cysts may develop in the same general area.
Lipomas are soft, fatty lumps that grow under the skin.
Lipomas can join with the skin, even though they do not originate from the skin itself. They grow slowly and usually cause no problems and are not painful. Sometimes, they are grow so large that they become uncomfortable due to rubbing or restricted movement. They can occur anywhere in the body where there are fat cells. Some lipoma are in between muscles, and can impact the function of the muscle.
Very rarely, the lump may be one end of the spectrum of a more serious condition called liposcarcoma, in which case it would need to be removed as completely as possible.
Management of Lipoma
An ultrasound is required to assess the size and extent of the lipoma, and its relationship to surrounding tissue.
Excision involves a cut over the lipoma, separating the skin overlying the lipoma, and removing the lipoma as completely as possible.
The cavity that is left behind sometimes fills up with body fluid called “seroma” that can take several weeks to absorb.
Liposuction has been described as an alternative to excision, but it is difficult to be sure if the lipoma was entirely removed with this technique.
If some lipoma cells are left behind, they can grow again, and therefore a recurrent lipoma can appear at the same site.
Once removed, the lipoma is sent for analysis. On the very rare occasion that it is a liposarcoma, further surgery is warranted, to ensure a wider margin of excision.