Lumps & bumps

What are skin lumps and bumps?

Growths on the skin or just beneath the skin can be caused by a variety of conditions, most types of bumps on the skin are caused by benign or harmless growths. Despite this, they can still cause discomfort and pain from friction, clothing, or getting caught in jewellery.

Types of growth

Among the common types of lumps and bumps found on the skin include:

• Seborrheic keratosis – Seborrheic keratosis are benign growths of keratinocytes, appearing as scaly, brown or black papules or plaques on the skin. These growths are common in people aged 50 years and above [1].
• Moles – Moles are dark spots of melanocytes on the skin. They can appear at birth, or develop throughout your life. These growths are typically harmless, but some may potentially develop into skin cancer.
• Skin tags – Skin tags are characterised as small, pedunculated lumps of skin. Skin tags typically appear in areas of the body that experience a lot of friction, such as the neck, armpits, groin or thighs, and eyelids [2].
• Cysts – Cysts are lesions under the skin often filled with pus, fluid, or other material. Cysts are typically harmless, but can grow and rupture, which may lead to infection and inflammation, hence requiring treatment.
• Lipomas – Lipomas are lumps of fatty tissue under the skin which are often mobile or moveable. These lesions are typically harmless and slow-growing. However, their location or size may eventually cause pain or discomfort.
• Warts  – Warts are typical growths caused by viral infections, and often present as rough, bumpy growths on the skin.

What causes these lumps and bumps?

• Seborrheic keratosis – Seborrheic keratosis lesions can be sporadic or inherited. In sporadic cases, it is believed that gene mutations of fibroblast growth factor receptor-3 (FGFR3) are what drives the development of the lesions. Seborrheic keratosis is also believed to be caused by increased UV radiation, such as from sun exposure [1].
• Moles – Moles, also known as nevi, are formed from clumps of melanocytes or pigment cells. Moles are typically grouped as common moles, congenital melanocytic nevi, or dysplastic nevi. The causes of moles are not entirely known, but certain features increase the likelihood of someone developing moles, such as fair skin, light hair and eye colour, and increased sun exposure [3].
• Skin tags – The exact cause of skin tags are not entirely known. However, certain risk factors that increase the likelihood of skin tag development include genetic predisposition, obesity, and insulin resistance [4].
• Cysts – Cysts that appear on the skin, or epidermoid cysts, are typically caused by a blockage in the follicles due to a build-up of keratinocytes. Over time, more and more keratinocytes are trapped, eventually forming a cyst. Injuries to the hair follicle can also cause the initial plug to form.
• Lipomas – Lipomas are benign tumours of fatty tissue. While the exact cause of lipomas are not known, it is believed that traumatic injuries and genetic predisposition may be linked to lipoma formation [5].
• Warts – Warts are benign growths of the mucosa and skin caused by viral infections. Infections of human papillomavirus (HPV) are known to cause different types of wart growths. Although mostly benign, some types of HPV are considered high risk and may develop into verrucous carcinoma [6].

When should I be worried about lumps and bumps?

Although most causes of lumps and bumps on the skin are benign, it is important to know when it may be indicative of a skin cancer lesion, or a lymphoma. Warning signs to look out for include:

• A new mole, or a mole that changes rapidly in a short duration of time
• A pearly or waxy bump (may be indicative of basal cell carcinoma)
• Lesions that do not heal, or comes back after healing
• Itchy or painful lesions
• Lesions that may look rough, scaly, red/pink/white
• Painless swollen lymph nodes, typically in the neck, armpit, belly, or groins
• Fever and night sweats
• Fatigue
• Unexplained weight loss

Any concerning symptoms should prompt you to visit a healthcare provider. Early detection and treatment of cancer can be life-saving.

Diagnosis of skin lumps and bumps

Some growths on the skin may resemble one another, and may even look similar to other more serious skin lesions. Hence, it is crucial that you visit a dermatologist for a proper diagnosis and avoid performing any at-home removals. Typically, your dermatologist will perform the following tests to diagnose your condition:

• Physical examination – Your dermatologist is likely able to diagnose your skin lesion or growth from a simple physical examination. They may give you recommendations for further tests if the lesion looks suspicious, or if it requires a differential diagnosis.
• Dermatoscopy – Dermatoscopy (sometimes dermoscopy) is an examination of the skin using a dermatoscope, which acts like a magnifying glass to closely examine the skin lesions.
• Skin biopsy – In some cases, if your doctor requires further tests for a diagnosis, they may perform a skin biopsy. The procedure involves taking tissue samples from the skin or lesion, commonly using surgical tools. The tissue samples will then be sent for further laboratory tests. Biopsies are important for the diagnosis of potentially malignant lesions.
• Imaging tests – Certain growths may benefit from imaging tests such as ultrasound and magnetic resonance imaging (MRI). Typically, your dermatologist will look at the contents of lipomas or large cysts using imaging tests, this can also be helpful for your dermatologist to plan for the removal procedure if indicated.

Treatment for skin lumps and bumps

Most of the lumps and bumps on the skin are likely to be benign, and may not require removal or treatment if they are not painful or bothersome. You may want to remove the growths for certain reasons, including for aesthetic purposes. Depending on the type of growth, your dermatologist may use the following procedures for removal or treatment:

• Surgical excision – Surgical removal with a scalpel is among the most common removal methods for skin lumps and bumps. Typically, large and deep lesions, such as lipomas, cysts, and moles may benefit from surgical removal. In certain cases, your dermatologist may also remove a small border of healthy tissue from the surrounding lesion to reduce recurrence of the lesion.
• Incision and drainage – Incision and drainage is commonly done on lesions filled with fluid, pus, or other encapsulated material. Incision involves making a smaller cut, hence minimising scarring after healing.
• Electrosurgery – Electrosurgery involves the use of electric currents to destroy tissues. Several forms of electrosurgery include electrofulguration, electrocautery, electrodessication, and electrosection. Electrosurgery can be done on soft tissue growths such as warts, seborrheic keratosis, moles, or skin tags. Electrosurgery also reduces bleeding [7].
• Cryotherapy – Cryotherapy involves the use of extremely cold temperatures, using liquid nitrogen, to freeze and destroy soft tissues. As the tissues die, it will gradually slough off on its own.
• Laser removal – Laser removal methods involve ablation of the targeted lesion, this method can be used for moles, skin tags, warts or seborrheic keratosis lesions.

Ultimately, your dermatologist will decide which treatment method is the most suitable for your condition. It is important to consult with your doctor and convey your concerns and preference as well.

Summary

Skin lumps and bumps may be a cause of discomfort and can negatively impact your self-esteem. Fortunately, removal and treatment of the lesions are widely accessible. However, it is important to perform a proper check and diagnosis before undergoing any removal procedures. Certain benign growths may become cancerous and spread if the wrong treatment is performed.

If you have any doubts or concerns regarding skin lumps and bumps, or if you would like to schedule a consultation session with our dermatologists, reach out to us to book an appointment now.