Lifestyle Choices

The medical meaning of the word tumor is simply a swelling or lump raised above the skin surface. Although some tumors are cancers, most are not and the word can be applied to something as harmless as a wart.

Harmless skin lumps of one type or another are exceedingly common: in fact everyone has one or more at some time in their life. Although moles, which are raised, could also be considered here they are dealt with in detail in the section on birthmarks and pigment. This section deals with both harmless or benign lumps as well as true cancers or malignant lumps.

Harmless lumps

Cysts

Sebaceous cysts sound as though they should be full of sebaceous fluid or sebum, but they are not. They are filled with keratin from a hair follicle or the epidermis. They grow most frequently on the scalp as firm rounded bumps and the size may vary from half a centimeter to that of a potato. Often more than one will develop and in some families there is a tendency to multiple cysts. The problem is usually cosmetic but a larger cyst may interfere at the hairdressers. If an infection develops within it, it becomes hot and tender and may discharge a nasty- smelling material. Unfortunately the occurrence of such an infection may interfere with its subsequent removal. In that case, instead of the sac being freed and pulled out through a small slit in the skin, it becomes stuck down, making removal difficult.

Skin tags

They are also known as fibro-epithelial polyps and are found mainly around the neck, in the armpits and groins. A typical specimen is a small, pear-shaped piece of skin. Often they are multiple and look like squashed mushrooms. The common complaint is that one or more catches on a necklace, shirt collar, vest, pants etc. Fat people have more skin tags than thin individuals and it is a good idea to lose weight if skin tags are becoming a problem. The simplest treatment is to tie a piece of thread round the stalk and the tag will then drop off in its own time. They can also be snipped off with sharp scissors, and small tags will often not bleed.

Skin Scars

Any significant injury will leave a scar which may be completely flat or raised. Some are bumpy, and if it becomes painful and bigger than the original wound or injury it is called a keloid. They may appear in acne scars, after surgery or after an accident. Some body sites are more prone to the production of keloids, the skin between the nipples and the nose, and the equivalent area on the back, being the worst of all. This is so to such an extent that doctors are much less keen to perform cosmetic operations in these areas for fear of a lumpy scar. Black- skinned people suffer particularly from this problem. While surgeons may be happy to deal with some types of ugly scar they will not want to do this in the case of a keloid because another and even bigger one is likely to occur round the new wound. Keloids can, however, often be helped by the injection of steroids into the scar.

Skin Pyogenic granuloma

This is a less frequent response to injury, often seen in children and young adults. It is a red, round, often weeping tumor composed almost entirely of blood vessels. The site is usually where a pin, a thorn or some other sharp object has penetrated the skin. The finger, hands or lips are frequently involved. This tumor should always be seen by a doctor to check on its features and to arrange treatment. After the injection of some local anesthetic the pyogenic granuloma can be scooped out with a curette.

Skin Dermatofibroma

Yet another skin lump which in some cases is a response to injury. These are hard, brown or pinkish tumors measuring up to one centimeter across and they are rarely tender. The commonest sites are the skin and calves of women. Dermatofibromas are completely harmless and in many cases are thought to be an odd scarring reaction to insect bites. Many will shrink over the years and it is not necessary to remove the lump unless it is unsightly or awkward, for example, lying beneath a shoe strap.

Skin Corns and callosities

Callosities are nearly always painless and need no treatment. When the repeated friction stops the thickening slowly disappears. Corns and seed corns are seen mainly where there is a high local pressure and are commoner in the middle-aged and elderly. The typical site is on the Foot where a bony area is pressed against a shoe, for example on top of the toes, and on the soles just below the base of the toes. On the soles they are often confused with verrucae but can be distinguished by paring down with a blade. A wart will be seen to have a rough surface, no normal markings and possibly black flecks of thrombosed capillaries. A corn, however, has normal skin markings and a solitary ’seed’ of keratin at the center. Soft, soggy corns can arise in the third and fourth toe clefts where the toes are cramped together by tight shoes. A white, thickened, macerated area is seen and is tender to touch.

Skin Seborrheic warts

They are also called seborrheic keratoses or less politely, senile warts. It is true that they are much commoner in old age but they also develop in people as young as twenty years. However, multiple examples on the back or chest are rare in young people. Seborrheic warts are harmless skin growths which have a rough or warty surface and vary from black to light brown in color. Telling them apart from other, more serious, growths is usually simple but occasionally it proves more difficult and the wart has to be removed and examined under a microscope.

Treating obvious seborrheic warts is only necessary should they be itchy or unsightly. Various methods can be used including cryotherapy, curettage or excision.

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