Tuesday, April 23, 2013

Bumps and lumps

We get a lot of anxious patients worried when they find a variety of bumps/lumps on their bottoms and other locations.  Starting in the more southerly location, what should be the most concerning and what can wait to be evaluated?  Certainly anything causing severe pain we want to see sooner than later to get you relief.  This would include Bartholin's cysts/abscesses (usually the largest things we see and among the most painful).  They usually require surgical drainage to get better.

Herpes lesions, especially in large clusters, can be extremely uncomfortable and require medication for pain, for the viral infection and sometimes even urinary catheterization if a patient can't urinate normally due to the pain.  In the more severe herpes outbreaks, lymph nodes in the groin can also become enlarged and painful.

Sometimes sebaceous cysts or hair follicles can become infected and fill with pus (an "abscess") requiring incision and drainage in the office or treatment with topical or oral antibiotics.  Genital warts are usually more embarrassing than painful, but are most often treatable with topical medication.  Occasionally surgical excision or laser treatment is used for extensive disease.

Sometimes we encounter benign cysts, usually inside the vagina and often related to the way a laceration healed after childbirth.  Rarely we encounter tumors in the genital area.

Moving north,  the other area of concern for bumps/lumps is the breasts.  Fortunately many of the lumps we find (or that patients come to us with) are benign cysts or tumors that are commonly found in breasts.  We are always conscious of the fact, however, that even our younger patients aren't immune to breast cancers.  The characteristics of a breast lump that are reassuring are when they are tender, move around well with the rest of the surrounding breast tissue, have smooth edges,  and often wax and wane in different areas of the breasts (especially with the menstrual cycle).  Concerning signs of a breast lump are when it doesn't have smooth edges or move around easily, when it does NOT feel tender, when it is hard and when it keeps growing in the same place in the breast.  Obviously, a family history of breast cancer is also of concern, but the absence of a family history doesn't mean one isn't vulnerable to breast cancer.  Most patients with a palpable mass will get an imaging study of some kind (mammogram =/- Ultrasound) and the more concerning lesions occasionally merit an MRI.  Needle or surgical biopsies are sometimes needed to tell whether a lesion is benign or not.

Skin tags are very frequently seen and can often be removed in the office if they are getting in the way of clothing/jewelry/etc.  Darkly pigmented, irregular, irritated/bleeding or rapidly growing lesions should be evaluated by a dermatologist for possible skin cancer/precancer.  People with risk factors such as a history of sunburns, very fair skin, abundant moles, or family history of skin cancer should schedule regular skin checks with a dermatologist as well.  

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