When to worry about a lump under the skin

Exploring skin lumps

In the intricate landscape of human health, encountering a lump under the skin can stir a mix of emotions—concern, curiosity, and perhaps a touch of anxiety. Yet, armed with knowledge and a keen sense of awareness, figuring out when such lumps may need more attention becomes a more manageable task. This guide aims to demystify different skin lumps, shedding light on both the benign and potentially hazardous varieties, while also empowering you to recognise when it’s time to consult a healthcare professional.

Skin lumps: from benign to beware

Common culprits:

1. Epidermoid cyst (also known as sebaceous cyst): Epidermal cysts are sometimes referred to as “sebaceous cysts,” but this can be misleading. Unlike sebum, the oily substance produced by sebaceous glands to moisturise the skin, epidermoid cysts are filled with keratin (a type of protein in the skin) and cellular debris.

An epidermoid cyst normally presents as a round or dome-shaped bump beneath the skin and often arise from hair follicles. These cysts are more common on the face, neck, around the ears, or upper torso/back, but can develop anywhere on the body. In some cases the cyst may have a ‘punctum’, a small, pore-like opening on the cyst that can sometimes look like a dark spot or dimple, and can be filled with a thick, yellowish, or cheese-like material.

Epidermoid cysts are usually firm and compressible to the touch that can move under the skin. They may range in size from small to large, sometimes slowly growing over time. While generally harmless, they can become inflamed, tender, or infected, causing pain and redness, particularly if trauma or infection is involved.

Squeezing is not advised! Instead it is best to talk to your healthcare provider if you suspect you have an epidermoid cyst or notice any changes/ bumps on your skin to assess and recommend the best course of action.

If a small cyst like this isn’t causing any issues, it’s best to leave it alone. Removing it often poses more risks, such as infection, bleeding, and scarring from minor surgery, than leaving it as is. Additionally, the likelihood of recurrence after surgery may be quite high. Because of these factors, it’s uncommon for these cysts to be removed on the NHS.

2. Lipoma: A lipoma typically appears as a rubbery-type lumps, usually dome-shaped. These benign tumours are composed of fatty tissue and can develop in any organ of the body, but are most commonly found in the skin. Benign tumours are slow growing and are non-cancerous. Many also never require any treatment. Areas most frequently affected include the shoulders, trunk, arms, bottom or thighs. Their texture can range from soft to firm, may vary in size, and don’t cause any changes in skin colour.

What causes lipomas is uncertain but they usually have no associated symptoms and are painless. While lipomas are generally harmless and do not require treatment unless they cause discomfort or cosmetic concerns, it’s advisable to seek medical advice if you have an existing lipoma diagnosis and notice rapid growth, changes in appearance, or if the lipoma becomes painful or tender. It is also important to note if there is a change in texture, i.e. becomes firm to touch, or if you develop open wounds or ulceration, or experience a change in sensation, such as numbness. Any new lump on the body should be checked out by your GP.

3. Boil: Boils often start off as bacterial folliculitis (bacterial infections of the small hair follicles in the skin). If the body cannot handle the infection or if left without treatment, bacterial folliculitis may spread into the surrounding tissue and develop into a hard, painful, pus-filled lump called a boil or furuncle. Boils often encompass multiple hair follicles and affect the surrounding skin. Over time, the boil may fill with more pus, becoming larger and more tender. If many boils form together, they become a carbuncle.

Boils can develop anywhere on the skin and for the most part they go away on their own, and you can help it along with some of the good hygiene practices listed below. But, if a boil persists for over 2 weeks without improvement, recurs frequently, or appears as a cluster (carbuncle), it’s advisable to see a GP. If the boil is on your face, the surrounding skin is hot, painful, and swollen, you feel hot and shivery, or if you have a weakened immune system from treatments like steroids or conditions such as diabetes, it’s recommended that you request an urgent GP appointment or call 111 for guidance.

What to do:

• Warm compresses: Soak a clean cloth in warm water and hold it against the boil for 10 minutes, four times a day.

• Keep it clean: If pus comes out, clean the area around the boil with antibacterial soap.

• Cover the boil: Use a dressing or gauze to cover the area until it heals.

• Good hygiene: Bathe or shower daily and wash your hands regularly.

• Pain Relief: Take paracetamol or ibuprofen if it causes you pain.

• Wash linens: Wash your towels and bedding at least once a week at a high temperature.

• Weight management: If you’re carrying excess weight and have boils between skin folds, weight loss may help the boil(s) resolve.

What not to do:

• Avoid touching: As tempting as it may be, try not to pick, squeeze, or pierce a boil.

• No sharing: Do not share your towel, clothes or other items that touch your skin with others until the boil has healed.

• Avoid public facilities: It is best to avoid swimming pools or gyms until the boil is gone to prevent spreading the infection.

4. Abscess: An abscess is a localised collection of pus within tissues, often resulting from a bacterial infection. Unlike a boil, abscesses can occur anywhere in the body, including internal organs. They may present as swollen, tender, and warm areas with redness, and can vary in size. Abscesses can develop in various locations, such as the skin, gums, teeth, internal organs, or in the perianal region (around your bottom).

Abscesses on the skin may resemble boils, but they can also occur in areas without hair follicles. You are more likely to get an abscess if you smoke, are obese, are diabetic or if you have a pre-existing skin condition like eczema.

Treatment varies depending on the abscess type: it may involve incision, drainage to remove the pus, and/or antibiotics to clear the infection. Seeking medical advice is key, especially if the abscess is large, painful, persistent, or accompanied by fever or spreading redness, as prompt treatment is necessary to prevent complications and promote healing.

5. Ganglion: Ganglions are non-cancerous cysts filled with a jelly-like material, often appearing as a dome-shaped lump near joints or tendons, are typically soft and rubbery to the touch. Common locations include the wrists, hands, fingers, but they can occur on or along any joint. The exact cause of ganglions is not fully understood but small, repeated traumas that damage connective tissue are thought to play a role.

Ganglions vary in size and are usually asymptomatic. While they are usually harmless, causing little to no pain they may cause discomfort, limit movement of the affected joint, or feel tender, especially with pressure or movement. You may require medical attention if they become painful, increase in size, or interfere with joint function. If you notice persistent or worsening symptoms associated with a ganglion, it’s advisable to seek medical advice for proper evaluation and management.

6. Lymph node enlargements: Lymph node/ lymph gland enlargement, often noticed as swollen lumps under the skin, can occur in areas such as the neck, under the chin, armpits, or groin. These glands may feel firm or tender to the touch and can vary in size from a pea to a kidney bean, or even larger. Swollen lymph nodes may indicate an infection, such as a cold, but they can also signal more serious conditions like immune disorders or cancers.

If you notice swollen lymph nodes and…

• They’re getting bigger or haven’t gone down within a week.

• They feel hard or do not move when you press them.

• You’re experiencing night sweats or have a very high temperature (feeling hot and shivery).

• You have no other signs of illness or infection.

• You have swollen lymph glands just above or below your collarbone (the bone that runs from your breastbone to each of your shoulders).

…it’s important to not self-diagnose and to seek medical advice for proper diagnosis and treatment.

When to raise the alarm: signs and signals

Recognising red flags

As you navigate the terrain of skin lumps, making yourself aware of certain signals can prove helpful:

• Pain: Persistent or escalating pain associated with a lump may indicate underlying inflammation or infection.

• Changes in skin colour/temperature: Discolouration or localised warmth around the lump can signify an evolving infection and may need medical attention.

• Redness: Persistent redness or spreading redness around the site of the lump.

• Swelling: Swelling that worsens over time or extends beyond the immediate area of the lump.

• Pus or drainage: Any discharge from the lump that is thick, yellow, green, or foul-smelling.
  

If you experience any of the following symptoms alongside a skin lump (like a suspected or confirmed abscess), you may be developing signs of sepsis and should seek emergency medical attention immediately:

• Intense shortness of breath

• Fainting or passing out

• High fever or abnormally low body temperature

• Mental confusion or disorientation

• Slurred speech

• Cold, clammy, and pale or blotchy skin

• Rapid heartbeat and/or breathing

• Chills and shaking

• Severe muscle aches

• Dizziness or lightheadedness

• Nausea and vomiting

• Diarrhoea

For more information on sepsis, please visit the NHS sepsis webpage.

Seeking expertise: who and when?

While many lumps are benign and require no intervention, you should consider consulting your GP if:

• The lump feels hard or firm.

• The lump causes pain.

• The lump is increasing in size.

• The lump persists beyond two weeks.

• You experience general malaise, accompanied by fever or flu-like symptoms.

• Unintended weight loss occurs.

• Any additional unexplained symptoms emerge.

• The lump reappears following its removal.

Addressing acute concerns:

In instances of acute infection marked by severe pain, fever, confusion, difficulty breathing, a rash that does fade when you roll a glass over it or blue/grey/blotchy skin, lips or tongue, prompt medical attention via A&E or 999 is advised.

Location, location, location:

• Anatomical significance: Lumps situated in areas such as the breast, testicles, neck, armpits, or groin warrant closer scrutiny due to their proximity to vital structures.

Breast and testicular lumps

Lumps in the breast and testes can signal underlying health concerns, including cancer. Performing regular self-exams is important for early detection, which can lead to more effective treatment and improved outcomes. All breasts are different and regular self-exams help you to become more familiar with your body, making it easier to notice any changes or lumps that may require medical attention. By incorporating self-exams into your routine, you can take proactive steps to monitor your health and address any concerns by recognising what is normal (or not normal) for you!

How to perform a breast self-exam

1. Choose the right time:

• For women, the best time to perform a breast self-exam is a few days after your menstrual period ends when your breasts are least likely to be swollen or tender.

• Post-menopausal women can choose a consistent day each month, such as the first of the month.

2. Step-by-step breast self-exam:

• In front of a mirror:

i. Stand or sit with your shoulders straight and your arms on your hips.

ii. Look for any changes in the shape, size, or appearance of your breasts. Check for dimpling, puckering, or changes in the skin.

iii. Raise your arms and look for the same changes.

iv. Look for any signs of fluid coming out of one or both nipples (could be watery, milky, or yellow fluid or blood).

• Lying down:

i. Lie down and place a pillow under your shoulders if you wish. Place your right arm up beside/behind your head.

ii. Use your left hand to feel your right breast. Use a firm, smooth touch with the your middle three fingers of your hand, keeping the fingers flat and together.

iii. Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

iv. Follow a pattern to ensure that you cover the whole breast. You can move your fingers in circular motions, up and down vertically, or in a wedge pattern.

v. Repeat the process for your left breast using your right hand.

• In the shower:

i. Raise one arm behind your head.

ii. With the opposite hand, examine each breast using the same circular motions or up-and-down pattern.

3. What to look for:

• Any new lump or mass

• Any change in the size, shape, or appearance of the breast

• Pain in any part of the breast

• Nipple discharge other than breast milk

4. When to contact a healthcare provider:

• If you notice any unusual changes or find a lump, contact your healthcare provider for further information and investigation.

How to perform a testicular self-exam

1. Choose the right time:

• The best time to perform a testicular self-exam is during or after a warm bath or shower when the scrotal skin is relaxed.

2. Step-by-step testicular self-exam:

• Preparation:

i. Stand in front of a mirror. Look for any swelling on the skin of the scrotum.

• Examination:

i. Use both hands to examine each testicle. Place your index and middle fingers under the testicle with the thumbs placed on top.

ii. Gently roll the testicle between the thumbs and fingers. Feel for any lumps, smooth, rounded masses, or changes in the size, shape, or consistency of the testicles. Your testicles should feel smooth and firm but not hard.

iii. It’s normal for one testicle to be slightly larger than the other and for one to hang lower than the other.

iv. Locate the epididymis—a soft, tube-like structure behind the testicle that collects and carries sperm. Familiarise yourself with this structure so you don’t mistake it for a lump.

3. What to look for:

• Any hard lumps or smooth, rounded masses

• Any change in size, shape, or consistency of the testicles

• A feeling of heaviness in the scrotum

• Dull ache in the lower abdomen or groin

4. When to contact a healthcare provider:

• If you find a lump or notice any other unusual changes, contact your healthcare provider for a professional evaluation.

Additional considerations:

• Regularity: Perform the self-exam once a month to become familiar with the normal feel and appearance of your testicles.

• Prompt action: Early detection of changes can help with improve the success of treatment of testicular conditions, including cancer.

Finding a lump anywhere on the body can be worrying but in the journey of health and wellness, knowledge serves as both compass and companion, guiding us through unfamiliar territories with confidence and clarity. By acquainting ourselves with the nuances of skin lumps, recognising red flags, and knowing when to seek professional guidance, we can empower ourselves to better navigate these challenges.

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Reviewed by:

Anna Keeble MA BA Head of Content and Wellbeing Expert

Dr Claire Marie Thomas MRCGP DFSRH DTMH DipNLP MBChB BMedSci Medical Expert

References

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