Overview

Hard lumps are any surfaces of abnormally elevated skin having a swollen appearance, either on the surface of the epidermis or protruding from beneath the skin. Hard lumps/bumps under the skin are not rare and it is completely normal for an individual to have them at some point in their lives. Lumps tend to appear anywhere on the body surface due to several reasons, and are generally harmless. The not-so-concerning lumps are:

  • Hard or soft to touch
  • Mobile (that tend to move/change upon touch)
  • Pea size or that of a golf ball
  • Located on the outer skin surface (that hangs off the skin) or under the skin (in the fat layer of the skin)
  • Enlarges and causes pain upon physical activity and reduce in size upon relaxation

However, it becomes paramount to visit a physician for diagnosis if the lump has certain traits as listed below:

  • If the lump gets enlarged
  • If the lump is red, painful or warm
  • If the lump is rigid and non-motile
  • If the lump re-appears upon removal
  • If the lump is present in the testicles/breasts
  • If the swollen bump is in the armpit, groin or side of the neck that doesn’t subside

Common Causes

The following are some of the common causes of hard lumps:

Skin Cysts/Epidermoid Cysts

Epidermoid cysts (also termed as Keratin/Epithelial/Sebaceous cysts) are small, round-shaped lumps underneath the skin. These cysts are common that tend to grow gradually and are generally never cancerous. They can occur anywhere, though, they are commonly found on the head, back, face, neck or genitals. The cyst has a small blackhead in the center of the bump. It may leak a thick yellow foul-smelling material (keratin). The cysts are mostly painless and can become red/tender upon infection.

The cysts occur when the skills cells that are shed off (dead skin cells) move back into the skin, instead of falling off. They are also caused due to excess accumulation of keratin. Keratin, the naturally occurring protein in the epidermal cells, gets trapped beneath the skin due to certain disruptions to the hair follicle or skin (such as infections, trauma, acne or sun exposure). Also, at times, they are wrongly referred to as Sebaceous cysts. However, sebaceous cysts arise due to any damage to the sebaceous glands that produce oil, which enables to lubricate hair and the skin.

Prognosis & Treatment:

Majority of times, Epidermoid cysts don’t require any treatment. The practitioner generally can conclude the diagnosis by merely observing the cyst or scrubbing off the skin cells for microscopic examination. To obtain a detailed evaluation, laboratory analysis can be opted by taking a biopsy.

The following treatments can be sought if the cyst causes inconvenience or cosmetic problems:

  • Injection/Anti-biotics: Injections containing the drug to reduce swelling and inflammation can be administered. The physician may also prescribe antibiotics that enable to heal the lumps, if it is caused due to an infection/abscess.
  • Minor Surgical Incision and Drainage: With this procedure, the practitioner gives a minor cut to the cyst and drains out the content. It is a convenient method, though the cyst tends to occur again.
  • Surgery: The doctor can remove the entire cyst using a surgical procedure and then stitch it. This prevents the recurrence of the cyst.

Lipoma

A lipoma is a lump that grows gradually and is situated between the skin and the muscle layer underneath. They occur due to over-production of fat cells and are generally harmless and tend to be benign/non-cancerous growths. A lipoma can develop anywhere on the body where the fat cells are present, however, the common regions are shoulder, neck, trunk, armpits, thighs and chest. In rare cases, they also develop in internal organs, muscles or bones. Lipomas are colorless, dough-like soft to touch and move easily even on gentle prodding or pressure. Lipomas have a slow tendency to enlarge with a size range of about 2 to 3 centimeters (cm), and in occasional cases can grow up to 10 cm in size (giant lipomas). Also, they are more likely to develop in individuals between the age groups of 40 to 60.

The cause of lipomas is not completely understood and remains an area of research. As per the research studies, lipomas are genetic and tend to run in families. Individuals who inherit a faulty gene are at a risk of developing multiple lipomas, which is a rare condition known as familial multiple lipomatosis. Also, medical conditions such as Cowden syndrome, Gardner’s syndrome, Madelung’s disease, Bannayan-Riley-Ruvalcaba syndrome, and Adiposis dolorosa can cause lipomas. Some lipomas can also be a consequence of certain injuries that exert an impact on the area. Other contributing factors are obesity, high levels of cholesterol, glucose intolerance, liver disease and diabetes.

Prognosis & Treatment:

Lipomas generally don’t pose a threat. In case, the lump is bothersome causing discomfort, the following treatments can be opted:

  • Surgery: After administering local anesthesia, lipomas can be removed through surgical excision. Though, at times, lipomas tend to re-appear even after surgical removal.
  • Liposuction: In this process, the lump is cut and a thin hollow tube is inserted into the incision. And the tube is used to suck the mass of fat cells from the area. The excised lipoma material is further sent for laboratory analysis.
  • Steroid-based injections: These injections can be administered directly onto the affected area. It enables us to shrink the lipoma, however, does not lead to complete removal.

Swollen Lymph Nodes

Lymph nodes are small bean-shaped glands that are an essential part of the immune system. These glands separate out the hazardous substances from the lymph fluid (a clear, translucent liquid that travels through the lymphatic vessels). Functionally, they store and produce WBC’s (White Blood Cells) that destroy the infection-causing pathogens/microbes and waste. At times, exposure to viral/bacterial infections, tooth infections, cellulitis, ear infections, other medical ailments affecting the immune system (rheumatoid arthritis/lupus) can result in inflamed lymph nodes. Also, allergies to certain medicines can cause the lymph nodes to swell. Thus, making them hardened and painful. The swollen lymph nodes generally develop in the armpits, head, neck or groin region.

Prognosis & Treatment:

Majority of times, lymph nodes that are swollen, heal on their own without any medical therapy. Physical examination, CBC (Complete Blood Count), Chest X-ray/CT (Computerized Tomography) and Lymph node biopsy are done to evaluate the underlying causes.

The following treatments are sought to treat the not-so-serious cases of Swollen Lymph Nodes:

  • Antibiotics/Anti-viral Medications: Swollen lymph nodes caused due to infections are treated with anti-viral drugs/antibiotics, upon prescription by the practitioner. Aspirin/Ibuprofen/Acetaminophen/Naproxen are advised to treat pain and inflammation.

Also, applying warm compresses and taking adequate rest can help manage the symptoms. However, in severe cases, such as Immune-related disorders or Cancer, relevant medical treatments are to be taken.

Keratoacanthoma

Keratoacanthoma is a dome-shaped lump resembling a boil/pimple that grows out of the skin cells. At times, it could be a pre-stage to SSC (Squamous Cell Carcinoma)/Non-Melanoma Skin Cancer. However, as per research studies, there tends to be a slight difference between the two in gene expression. Keratoacanthoma lumps tend to appear on the sun-exposed skin such as the face, hands, and arms. These lumps grow about 2-3 cm in size, having a core filled with Keratin and a pinkish flesh-colored tone.

Keratoacanthoma lumps are more common in older adults with darker skin than ones with lighter skin tones. The causes of these lumps are attributed to sun exposure, HPV (Human Papillomavirus) infections, genes, fragile immune system, and carcinogenic agents. Multiple Keratoacanthomas are caused due to certain rare medical conditions. The lumps can be itchy and painful, though are generally harmless and heal on its own.

Prognosis & Treatment:

Keratoacanthoma is diagnosed through pathological investigations by sending a biopsy. The following treatments can be opted to treat these lumps:

  • Cryotherapy: Cryotherapy uses cryogens (such as liquid nitrogen/carbon-dioxide snow/Dimethyl Ether and Propane) to freeze the lumps/skin lesions. The dried, dead scab tends to fall off within a few days of treatment.
  • Electrosurgery (Curettage and Cautery): In this treatment, local anesthesia is administered to the area of treatment. The affected skin area is then scraped off using a curette and cauterized with a warm wire beaded tip/electrosurgical unit. This enables to curb bleeding and destroy the remaining damaged cells.
  • Excision: Excision biopsy is a treatment that removes the complete area by surgically cutting it off. Local anesthesia is administered on the area to be treated and is cut off using a scalpel/sharp scissors, leaving an appropriate margin of unaffected tissue. And then the blood vessels are coagulated with a cautery.
  • Radiotherapy: In this treatment, X-rays with different energy levels are targeted at the affected area to destroy the damaged cells.

Fibroadenoma

Fibroadenoma are non-cancerous/benign breast lumps, that occur mostly in women aged between 15 and 35. These are painless and motile round-shaped lumps, with a firm/rubbery feel. Fibroadenomas tend to differ in size and can expand/shrink on their own. The fibroadenoma lumps can develop in either one or both the breasts. The exact causes of fibroadenomas are unknown.

However, they develop due to increased levels of estrogen. They also tend to grow during pregnancy due to a surge in hormonal levels. Fibroadenoma lumps have also been linked to the consumption of oral contraceptives before the age of 20. These lumps tend to shrink during the menopausal phase and upon avoidance of certain foods/beverages such as chocolate, tea/coffee or soft drinks. Fibroadenomas do not necessarily have to be removed and can resolve on their own.

Prognosis and Treatment:

Fibroadenomas are generally examined manually or imaging tests (such as Mammogram/Breast ultrasound). Also, a biopsy can be taken for laboratory investigations. If the lump is large, increasing in size or causing symptoms, it can be treated in the following ways:

  • Excisional Biopsy/Lumpectomy: It is also termed as ‘breast-conserving surgery’ because only a certain portion of the breast is surgically excised, unlike in the case of mastectomy.
  • Cryoablation: In this method, a thin hollow needle (Cryoprobe) is inserted through the fibroadenoma and the gas is pumped so as to freeze and destroy the lump.

Dermatofibroma

Dermatofibromas are tiny, benign skin growths that tend to develop anywhere on the body, however, more commonly on lower legs/upper arms/back. More common in adults than children, these lumps tend to be pink, red, grey or brown in color and tend to contract inwards upon pinching. They are firm and dense to touch, like that of a stone, underneath the skin. Dermatofibromas are caused due to the build-up of extra cells, insect bites, minor injuries or in individuals with suppressed immune systems.

Prognosis and Treatment:

Generally, Dermatofibromas are non-hazardous and don’t develop into cancerous growths. Primarily, the physician diagnoses Dermatofibroma by visual inspection and may do the pinch-test to check for dimpling. The Dermatofibroma lump can be examined through a dermatoscopy for a magnified view, that typically a white area in the center bordered by pigmentation. Also, a biopsy could be taken in case of unusual and severe symptoms.

Though most dermatofibromas do not require treatment and these lumps are treated by following methods:

  • Cryotherapy: Cryotherapy uses cryogens (such as liquid nitrogen/carbon-dioxide snow/Dimethyl Ether and Propane) to freeze the dermatofibroma lumps. The dried, dead scab tends to fall off within a few days of treatment.
  • Shave Biopsy: A razor-like tool is used to scrape off the top layer of the skin. However, the deeper layers remain and there are possibilities of lump to show up again.
  • Laser Treatment: Laser therapy uses intense beams of light and heat to treat the damaged area, thus minimizing its appearance.

Hernia

Hernia is a bulge or lump that occurs when a part/organ of the body pushes through the surrounding tissue. It results due to weakened/holed peritoneum (muscular wall that holds abdominal organs). As the defective/fragile peritoneum allows the organs/tissues to herniate developing into a bulge/lump. Hernia lumps typically occur on the belly button, upper stomach area or the groin.

The causes of Hernia are attributed to aging, surgery, strenuous/exerting activity that puts pressure on the abdominal wall, obesity, inadequate nutrition, undescended testicles, smoking, enlarged prostrate and cystic fibrosis. Hernia in children could be due to congenital defects or weakened abdominal wall.

Prognosis and Treatment:

Unlike the other skin lumps, Hernia’s generally require treatment. In most cases, Hernia lumps tend to painless and won’t require medical treatment. However, in cases of pain/discomfort, treatments can be opted. The doctor diagnoses Hernia based on physical examination by feeling the bulge/lump in the abdomen/groin, which tends to enlarge upon any strenuous activity. Also, barium X-rays/Endoscopies can be done to detect Hernia. The following methods are opted to treat Hernia lumps:

  • Open Surgical Repair: In this treatment, incision is made and the Hernia is pushed off back or removed. And the surgical incision/wound is closed using sutures/staples/surgical glue.
  • Laparoscopic Hernia Repair: In this method, a laparoscope/tiny telescope attached to a special camera is inserted through a tiny hollow tube (cannula) that gives the view of the hernia and neighboring tissue to the surgeon on a video screen. Generally, multiple incisions are required and the surgical mesh is placed on the defective hernia and fixed using surgical glue/staples/sutures.

Cherry Angioma

Cherry Angioma’s or red moles are commonly occurring skin growths made up of tiny blood vessels/capillaries that give them a reddish appearance. They are harmless, benign growths that tend to develop in adults aged over 30. The bright red, oval/round shaped bumps can vary in size and are generally less than an inch. They can develop anywhere on the body but are most commonly found on arms, legs, stomach, and chest.

The exact causes of Cherry Angioma are not yet fully known but are attributed to genetics, pregnancy, chemical exposure (particularly bromide compounds), certain medical problems and climatic conditions. Though these lumps don’t pose any threat, they can be opted to remove for cosmetic purposes.

Prognosis and Treatment:

These lumps are easy to diagnose due to their characteristic red color and lobular pattern as observed on a dermatoscopy. In uncertain cases, biopsy can be done. Cherry Angioma can be removed by the following methods:

  • Electrocauterization: In this method, a grounding pad is placed beneath the body to prevent burns and an electric current is administered through a tiny probe that burns and removes the angioma.
  • Cryotherapy: Cryotherapy uses cryogens (such as liquid nitrogen/carbon-dioxide snow/Dimethyl Ether and Propane) to freeze and destroy the cherry angioma bump, after which the dead scab falls off.
  • Laser therapy: The angiomas tend to absorb the high energy beams that the laser passes through the skin, causing them to vanish or turn greyish in color.
  • Excision: In this method, the area is completely cut off using surgical devices (such as scalpel/scissors), which can lead to scarring.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140092/
  2. https://journals.sagepub.com/doi/10.1258/shorts.2010.010046
  3. https://dpcj.org/index.php/dpc/article/view/dermatol-pract-concept-articleid-dp0603a02
  4. https://www.karger.com/Article/Abstract/335690
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