Patients are often referred to Austin Surgeons for the treatment of various lumps and bumps that can develop under the skin. These can form on any part of the body. Common types of lumps include lipomas, sebaceous cysts, enlarged lymph nodes, and abscesses.
The most common skin lumps we see are lipomas, which are benign fatty tumors. These can grow over time and cause symptoms like pain and tenderness. Lipomas can become quite large and visible.
Sebaceous cysts are the most common type of skin cysts. These are collections of the body’s natural oils that become trapped under the skin. They can have a thick, white discharge. Sebaceous cysts can become infected and cause abscesses.
An abscess forms if a bacterial infection develops under the skin. The affected area will be swollen, painful, tender, red, and warm to touch. These infections can be serious, and surgical drainage is usually necessary. Depending on the severity of the infection, drainage may be done in the office or in the operating room.
Lymph nodes are part of your lymphatic drainage system and are located throughout the body. These can sometimes be felt in the neck, armpits, or groins. Lymph nodes can become enlarged due to inflammation or infection, and sometimes because of cancer.
Most skin lumps are not cancerous, but it is important to have any new lump evaluated by your family physician. Lumps that are enlarging, becoming painful, or are changing in any way should also be evaluated by your physician.
Evaluation
Evaluation of skin lumps and bumps starts with an examination in the office. Often, that is sufficient to make a diagnosis. Occasionally, further evaluation with radiological imaging can be needed to make a diagnosis or determine the most appropriate treatment. Ultrasound, CT scan, and MRI scan are imaging studies that can be helpful.
Treatment
Treatment for skin lumps and cysts might include simple observation or surgery. For example, small, asymptomatic lipomas that have been stable over time may require no treatment at all. Other lumps may require surgical removal. Abscesses might initially require drainage to control the infection, and further surgery at a later time to remove the cyst that served as the source of infection.
Surgery
Your initial visit at Austin Surgeons will be a consultation to evaluate the lump. If a decision is made to perform surgery, it will be scheduled on a later date. Your surgeon will determine if the procedure can be done in the office under local anesthesia, or if it needs to be done in an operating room under sedation or general anesthesia. Drainage of an abscess may be performed immediately and involves making a small incision in the skin over the abscess under local anesthetic. After draining the infection, a dressing is applied.
Recovery
The following FAQ’s will help you know what to expect after excision of a lump or cyst. These are general guidelines. Your surgeon may make other recommendations based on your individual situation.
How should I care for the surgical area?
For the first two days after surgery, it is very helpful to apply ice packs to the area for 20 or 30 minutes at a time. Do this several times each day. This helps minimize pain and swelling at the site. It is usually not necessary to apply antibacterial ointments or other products to the incision.
When can I take a shower?
- If your incision is sealed with surgical glue and there is no gauze dressing, it is waterproof, and you can take a shower the next day.
- If there is a gauze dressing, you may take a shower the next day with the dressing in place and then remove the dressing after your shower. Gently dab the area dry.
- If the incision is covered with white steri-strips, it is not necessary to replace the gauze dressing, but leave the steri-strips in place.
- If there are visible stitches, you may replace the dressing with gauze and tape or a similar bandage. It is also ok to leave it without a dressing.
Starting the second day after surgery, steri-strips and stitches can get wet in the shower. Gently dab the area dry after the shower.
How should I manage pain?
Pain from the surgery is often mild and can be managed with over the counter (OTC) pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil). These two medications work to relieve pain in different ways and can be taken together or alternated. Do not exceed the maximum dose recommended on the label, and do not take these medications if you have an allergy or intolerance to them. If a stronger narcotic pain medication is prescribed, you should take the least amount necessary and switch to OTC meds as soon as possible. For the first few hours after surgery, the area may feel numb until the local anesthetic wears off.
If I have a drain tube, how do I care for it?
Twice a day (morning and evening) you should empty the drain, measure the output, and record the amount on a log. Re-set the drain by squeezing it flat and then closing the stopper. Bring the log to your post-op appointment.
There will be a dressing over the drain site. If the dressing stays dry, you don’t need to change it. If the dressing gets wet or starts to peel off, you can replace the dressing as needed with a small piece of gauze and tape, or a large band aid.
When you are in the shower, you can run a string through the tab on the drain and wear it like a necklace around your neck. You can also use a nametag lanyard for this.
When do steri-strips come off?
Steri-strips usually start to peel off after 10-14 days. As that point you can gently take them off.
When does surgical glue come off?
Surgical glue usually starts to peel off after 10-14 days. At that point you can gently peel it off or wash it off with soap and water.
When are external stitches removed?
External stitches are usually removed in your surgeon’s office about 10-14 days after surgery.
When should I follow up at my surgeon’s office?
If you have a drain tube in place, you should follow up after 1 week. If you have external stitches, you should follow up around 10-14 days after surgery. If you have steri-strips or surgical glue, you can follow up after about 2 weeks.
What can I expect at the site of surgery?
Manageable pain, swelling, firmness, bruising, a small amount of seepage, and itching are all common and no cause for concern. Sometimes some fluid can collect in the space where a mass was removed, and this will usually re-absorb with time.
What symptoms should I be concerned about?
You should call your surgeon’s office if you have unmanageable pain, severe swelling, active bleeding, or signs of infection like fever, spreading redness, or foul-smelling drainage. You should also call if you have a drain tube that is malfunctioning.
When can I resume normal activities?
You can resume normal light daily activities right away. If your procedure was performed with sedation or general anesthesia, you should not drive until the day after surgery. You should refrain from vigorous exercise or other activities that put stress on the incision for two weeks. You should not immerse the incision under water (tub, pool, lake, etc.) for two weeks. Your surgeon will discuss further resumption of activities at your post-op visit.
Risks & Complications
Most patients recover very well from this type of surgery. Risks of surgery can include bleeding, infection, wound healing problems, scarring, recurrence of the mass or cyst, injury to nearby structures such as nerves or blood vessels, the need for further surgery, and other possible complications. Please be sure to ask your surgeon if you have any questions or concerns.