This document discusses various types of skin swellings and lumps. It defines swelling and lumps, and discusses examining factors like size, shape, and skin characteristics. Common superficial causes of lumps are then outlined, including sebaceous cysts, lipomas, and neurofibromas. Diagnosis is usually clinical based on appearance. Treatment options are provided for each condition, often involving surgical removal if causing symptoms. Malignant growths like basal cell carcinoma and squamous cell carcinoma are also summarized, providing characteristics, risk factors, diagnostic approaches, and treatment options.

1. Skin swelling and lumps
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By Dr Rahman

2. Definition
 swelling denotes enlargement or protuberance in
any part of the body
 Can be called ‘’mass’’ or ‘’lump’’
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3. History
 Duration
 Mode of onset & progress (trauma or spontaneous;
rate of progression)
 Pain
 Fever
 Other lumps or swellings
 Other features (movements, secondary changes
loss of weight or appetite)
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4. Examination
 Site
 Size
 Shape
 Surface (smooth : epidermoid cyst, lobular or irregular)
 Skin (tense, glossy with prominent veins)
 Surrounding area (changes, pigmentation/edema, wasting,
discoloration)
 Others (number, colour, edges, extent, movements)
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5. Most common causes
 Swellings or lumps which are superficial to the
underlying muscle and fascia are commonly caused
by:
 Sebaceous cysts (epidermoid cysts)
 Lipoma
 Neurofibroma
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6.  Most common
cutaneous cysts
 Can occur anywhere
the body and
present as a skin-
dermal nodules,
a clinically visible
punctum.
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7. Diagnosis
 Diagnosis usually clinical,
based upon the clinical
appearance of a discrete
nodule or cyst, often with a
central punctum freely movable
on palpation.
 Cyst wall consists of squamous
epithelium similar to skin
surface.
 Cavity filled with laminated
layers of keratinous material.
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8. Treatment
 Inflamed uninfected epidermoid cysts may resolve
spontaneously without therapy, although they tend
to recur.
 Treatment not necessary unless desired by patient.
 Injection of Kenalog® into the inflamed lesion can
hasten the resolution of inflammation in uninfected
epidermoid cysts.
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9. lipoma
 lipomas are the most common
benign soft-tissue neoplasms.
 Consist of mature fat cells enclosed
by thin fibrous capsules
 Can occur on any part of the body
 Develop superficially in the
subcutaneous tissue
 Rarely, they may involve fascia or
deeper muscular planes
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10.  Soft, painless subcutaneous
nodules ranging in size from1
to > 10 cm
 Occur on the trunk and upper
extremities and can be round,
oval or multi-lobulated
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11. lipoma
 Patients may have more than
one lipoma, occasionally
patients can have genetic
condition : development of
multiple lipomas in several
family members
 Malignant transformation of a
lipoma into a liposarcoma is
rare
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12. Diagnosis is made
clinically
 If suspected lipoma
causes symptoms (pain or
restriction of movement), if
it is rapidly enlarging , or is
firm, then a biopsy is
indicated
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13. Treatment
 Treatment indicated if pain or for cosmetic purposes or
concerns over diagnosis
 Surgical removal of the fat cells and fibrous capsule
 Recurrence of an excised lipoma is not common
 Side effects of surgery includes : scarring, seroma, and
hematoma formation.
 Surgical technique with segmental extraction and minimal
surface incision may limit the scar size.
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14. Neurofibroma
 Cutaneous neurofibromas are
benign nerve tumors
composed of cells of
neuromesenchymal origin.
 Cutaneous neurofibromas
occur as sporadic, solitary
lesions in healthy adults.
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15. Neurofibroma
 Asymptomatic, soft, flesh-
colored or hyperpigmented
papules or nodules that
are <2 cm in diameter.
 Multiple cutaneous
neurofibromas and their
variants may occur in the
setting of
neurofibromatosis
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16. Diagnosis
 Soft, flesh-colored papules
or nodules.
 Applying direct pressure to
some neurofibromas may
make them seem to retract
into the skin, a finding that
has been described as the
‘’button-hole’’ sign.
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17. Treatment
 Treatment is not necessary for solitary cutaneous
neurofibromas.
 Surgical excision can be used to remove lesions
when the diagnosis is in question or when removal
is desired due to discomfort or cosmetic concerns.
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18. Malignant
 Basal cell carcinoma
 Squamous cell carcinoma
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19. Basal cell carcinoma
 the most common skin cancer (80%)
 Men >Women
 It increases with age (50-80 yrs )
 Rare in <40 yrs
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20.  a locally invasive
skin tumour and
rarely metastatize(<
0.01%)
 Head and neck 60%
 Nose 14%
 Trunk 30%
 Extremities 10%
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21. Characteristics
 The main
characteristics are:
 Slow growing: 0.5 cm in
1-2 years
 Skin coloured, pink or
pigmented
 Spontaneous bleeding
or ulceration
 Waxy papules with
central depression
 Pearly appearance
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22. Diagnosis
 To confirm and diagnose bcc and its
subtype Shave biopsy Punch biopsy
 Cytology
 Histologic findings
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23. Treatment
 Depends on
 size
 location
 and type of BCC
 Curettage and electrodessication
 Excisional surgery
 Radiation
 Cryosurgery
 Laser surgery 23

24. Squamous cell carcinoma
 SCC of the skin is a malignant tumor of
keratinocytes, arising in the epidermis.
 SCC usually arises in epidermal
precancerous lesions
 And depending on etiology and level
of differentiation, varies in its
aggressiveness.
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25. Etiology
 Age of Onset : Older than 55 years
 Sex : Males > females.
 Phototherapy, PUVA (oral psoralen +
UVA). Excessive photochemotherapy
can lead to promotion of SCC
(psoriasis)
 Race : persons with white skin and
poor tanning capacity
 Occupation: working outdoors—
farmers, sailors, lifeguards 25

26. Features
 Slowly evolving —any
isolated keratotic or
eroded papule or
plaque in a suspect
patient that persists for
over a month is
considered a carcinoma
until proved otherwise.
Also, a nodule evolving
 Rapidly evolving —
invasive SCC can erupt
within a few weeks and
is often painful and/or
tender. 26

27. Management
 Depends on localization and extent of
lesion
 excision with primary closure
 skin flaps, or grafting.
 Microscopically controlled surgery in
difficult sites.
 Radiotherapy should be performed only if
surgery is not feasible
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28. Prognosis
 Recurrence and Metastases SCC causes
local tissue destruction but it has a
significant potential for metastases.
 Metastases are directed to regional
lymph nodes and appear 1 to 3 years
after initial diagnosis.
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