Help! I have a growing lump! What do I do?
What are the possible causes of skin lumps?
There are many possible causes of skin lumps. The skin is a fairly complex organ made up of many types of cells. Lumps can grow from abnormalities from any of these cells.
What are some examples of common lumps (but benign lumps)?
Infections of the Skin can lead to abscess formation, which is usually painful and red. These lumps grow rapidly. Examples of such lumps include: Carbuncles and Furuncles. You should see your doctor as soon as possible because if you seek treatment of such lumps early, you may not require surgery to treat these lumps.
Skin Tags, Sebaceous cysts, Lipomas. These are largely benign lumps, but may look ugly. Most people may get these lumps removed for cosmetic reasons. However, the diagnosis of such lumps is not confirmed till the lump is removed. Hence, it may be prudent to get these lumps removed anyway.
Viral Warts. These lumps are caused by a virus that manages to penetrate the skin layer due to a crack in the skin. The virus rapidly grows and causes a lump to form. Generally, this lump may cause a bit of discomfort and hence, various treatments (topical creams, freezing techniques, and surgical excisions) can be done to get rid of such lumps.
Hemangiomas / Pyogenic Granulomas. These lumps generally bleed quite a lot when you accidentally bump against something. However, these lumps are not cancerous but can cause a fair bit of distress due to the bleeding. Hence, surgical removal is usually the way to get rid of such lumps. Do note that there is a risk of recurrence with such lumps despite best surgical techniques.
Less common, but dangerous lumps
Skin Cancers like Basal Cell Carcinomas, Squamous Cell Carcinomas. Such lumps should be removed as soon as possible. If the lump looks like Cancer on examination by your friendly neighbourhood doctor, it may be wise to get the lump removed by a dermatologically trained specialist surgeon
Can I just monitor the skin lump at home?
Can I just try out medicated treatment at home first?
It is advisable that you see your friendly neighbourhood doctor for a review of any growing lump. I have seen on many occasions, patients actually leave an abscess alone, which is growing for days to weeks, and ending up in hospital with a big operation. If only they had sought treatment earlier, at their doctor, they may have avoided a big operation in hospital! I have seen other cases also, patients applying steroidal creams on a lump that they thought was eczema; that lump turned out to be skin cancer.
It is highly recommended that for any lumps, you should seek a professional medical opinion before any treatment is started.
Does this lump require surgical removal?
Some lumps like small viral warts can be treated with topical creams or freezing techniques first. But most lumps may require surgical removal to be sure of the diagnosis. As alluded to earlier, there are many causes of skin lumps, and hence a professional medical opinion should be sought first before surgery is conducted.
What does minor surgery in a GP setting look like?
Minor surgical procedures in a General Practice clinic are really not as scary as you think.
For any surgical procedures, you should discuss with your doctor about the pros and cons of doing any surgical procedures in an outpatient setting. The first and foremost concern should be your safety. The clinic should have adequate resuscitation facilities on immediate standby should anything go wrong.
Any surgical procedure should consist of the following steps:
Patient education and consent for both anaesthesia and the intended surgical intervention
Preparing the surgical site to ensure sterility
Post operative care
For most minor surgical procedures in the outpatient clinic setting, it should take less than an hour from start to finish depending on the complexity of the case.
If I do surgery, what is the downtime and subsequent follow up?
Generally for most procedures, it is advisable for you to take some time off work to recover. If your job involves some manual work, it may be necessary for you to either switch to a less manual job scope during the recovery period.
Straight after your procedure, it may be necessary for you to completely rest for a day or two depending on the case complexity. Your doctor may prescribe some painkillers and antibiotics to help with the surgical recovery. It is advisable to take the painkillers even though there is no pain after the procedure (due to the local anaesthetic), because the pain may come in later.
You may also be required to follow up a day or two after the procedure for your doctor to check in with you and see how you are doing. The main aim of these follow up visits is to ascertain that the surgical site is healing well without any infection, and to make sure that you are all ok.
However, do note, for abscesses, you may require daily wound dressings and postoperative antibiotics to treat the infection and to allow the wound to heal properly. This is to reduce the risk of reformation of the abscess.
After your doctor is confident that you have fully recovered, or at least nearly fully recovered from the surgical procedure, your doctor will discharge you from the follow up. However, it is wise for you to know when and if you need to check in with your doctor.
When will my GP refer me to a specialist?
If your GP feels that the case is too complex (e.g skin cancer, or the lump is too big!) to be done in an outpatient setting, it may be safer for you to be admitted to a hospital for a specialist surgeon to do the procedure instead. In the hospital, there are more facilities available for the specialist surgeon to do the procedure safely, especially for complex procedures.