Benign Skin Disorders

Dear Dr. Z,

My wife has a fatty tissue near her lower back and it's very soft. The Doctors don't seemed to be concerned, but it causes discomfort and some pain. We don’t know, but it seems like it might be a cyst or something. I know this is not the best description, but this is of some concern to us.

Sincerely, Jane D., Phoenix, AZ

What are benign skin disorders?

The term “benign” skin disorders refers to a variety of skin conditions in which tumor or tumor-like lesions develop on the skin but have little or no cancerous potential. Three of the most common benign skin tumors are sebaceous cysts, lipomas, and ganglion cysts.

Sebaceous cysts, also known as epidermoid cysts, are slow-growing, painless nodules that grow just below the surface of the skin. They typically resemble the uppermost part of a hair follicle and are filled with a fatty, white, cheese-like material called sebum. Sebum is an oily material produced by our sebaceous glands that help prevent our hair and skin from “drying out.” Lipomas are benign tumors composed of fat. They are the most common tumors of soft tissue. Because lipomas are situated between your skin and an underlying muscular layer, they are freely movable, doughy to the touch, and generally painless. Ganglion cysts are non-cancerous fluid-filled bumps that typically develop near the tendons or joints in your wrists, hands, and less commonly, your feet.

What causes them?

The majority of sebaceous cysts are caused by blocked sebaceous glands, swollen hair follicles, or an over-production of testosterone. Too much testosterone causes an increased production of sebum, which in turn, can result in a blockage of the sebum-secreting sebaceous glands.

The exact causes of lipomas and ganglion cysts have not yet been identified. It is believed that the development of lipomas may be genetically-linked, indicating that a risk factor may include a family history of lipomas. Sometimes lipomas are detected after an injury or trauma to the skin. The cause of ganglion cysts hasn’t been determined either, but overuse of a specific joint may play a role.

Who gets it?

Sebaceous cysts can occur at any age but are more likely to develop in men during their 30s or 40s. They are especially common in people with a history of acne or recent injury to the skin. Lipomas tend to occur a little later in life and are most common between the ages of 40-60. An inherited condition can involve lipomas in children, but this is extremely rare. Ganglion cysts are more common in women and occur more frequently in people who do repetitive movements of the wrist and hand. A history of osteoarthritis may also increase our risk of ganglion cysts, as the overproduction of joint fluid from the arthritis can leak into the areas around your tendons, eventually forming a cyst.

What do they look like?

Sebaceous cysts are generally smooth to the touch, round in shape, and can vary in size from a few millimeters to 5 centimeters. They are more common in hairier or oily areas such as your face, scalp, ears, back, neck, and upper arms. The cysts are usually white or yellow in color but can be darker in people with darker skin. They may have a central opening from which a cheesy-like material may be expressed. Because sebaceous cysts can occasionally become infected, it is best to be seen by your “Medical Home” for treatment before this happens.

Most lipomas occur on the trunk, thighs, and forearms, but can be found anywhere on the body where fat is located. Lipomas are freely movable, soft nodules that can range in size. The vast majority are smaller than 4-5 centimeters but “giant” lipomas can grow as large as 10-20 centimeters. Smaller lipomas are typically painless but can become painful as they grow and press on nearby nerves.

Ganglion cysts look like fluid-filled lumps near your wrist or finger joints. Typically, these cysts are round, firm, smooth and don’t move. Because ganglion cysts are thought to be related to overuse and/or repetitive movements of the wrist and fingers, they’re size tends to be dependent on your activity level. They are larger at times of increased activity and smaller when you’re at rest.

How are they diagnosed?

If you notice a suspicious bump, you should visit your “Medical Home”. In most cases, your doctor can diagnose all three of these conditions based on the general appearance alone. If there is any question or doubt to the diagnosis, your doctor can order a number of tests including:

X-RAY: Can rule out other conditions such as arthritis or a tumor
ASPIRATION: Using a small needle, your doctor can withdraw some of the fluid to be further tested in a laboratory
MRI/CT/ULTRASOUND: Can be used to locate smaller, painful cysts that are not easily seen

Are there any complications?

INFLAMMATION Due to some irritation, the cysts can become tender and swollen
RUPTURE If the cyst ruptures, a boil-like abscess can form which will become tender and requires prompt removal
INFECTION Cysts can become infected spontaneously or after a rupture. Once again these cysts may become very tender, and require prompt removal.

Complications of lipomas are typically due to size. The majority are completely painless but can become painful as larger lipomas compress nearby nerves and/or blood vessels. Complications of ganglion cysts are usually due to interference with joint function or pain developing as the cyst grows.

How is it treated?

All three of these conditions generally require no treatment. In fact, the majority of people who seek treatment usually are unhappy with way the lesion “looks” and would like it removed for cosmetic purposes. In other cases, these lesions are removed because of pain, progressive growth, or interference with function of a nearby joint.

For sebaceous cysts that become infected, inflamed, or ruptured, an incision and drainage is the treatment modality of choice. After numbing the area with a local anesthetic the doctor will make a small incision, and drain the fluid within the cyst.

Most lipomas require no treatment either, but for painful or growing lipomas, treatment options include surgical resection.

Most doctors take a “wait and watch” approach with ganglion cysts because the majority will disappear with time. However, if the cyst is causing pain or interfering with the function of your hand, wrist, or fingers, the treatment option usually includes surgical resection as well. Please don’t hesitate to visit your local “Medical Home” for any questions or concerns about this or any other medical issues.

Menu Title

Warning: Unknown: open(/home/220588/data/tmp/sess_27c51a58fc69455e35ba802985af25a8, O_RDWR) failed: Disk quota exceeded (122) in Unknown on line 0

Warning: Unknown: Failed to write session data (files). Please verify that the current setting of session.save_path is correct (/home/220588/data/tmp) in Unknown on line 0