Lumps & Bumps
If you have noticed a lump or bump that was not there before, it needs furthur checking. 
Most of the time, it is harmless but sometimes, when caught early, it can help avoid a more complicated and serious condition. They are normally referred to in medical terms as tumours which are either benign or malignant
We can often tell you during an examination what it is likely to be and whether you require further testing such as blood test, FNAC or an ultrasound or scans.
Lumps and bumps are caused by a number of different conditions depending on which part of the body they appear.

Common types of lumps and bumps we diagnose and treat areas:

  • Sebaceous Cyst
  • Lipoma
  • Carbuncle
  • Hydrocoele 
  • Lymph nodes
  • Breast lumps8 
  • Pilonidal Sinus/ Abscess

Sebaceous Cysts
Epidermoid cysts, also called sebaceous cysts, are benign (non-cancerous) skin cysts formed by an outpouching from the hair follicle. Most commonly, epidermoid cysts are found on the genitals, chest, and back; but, they also can occur in other areas of the skin.
In general, epidermoid cysts have a round appearance. A dark portion of the cyst is visible on the skin. If the cysts become infected, they will become red and tender. When the cysts are squeezed, they can produce a cheesy white discharge.
The effective treatment of epidermoid cysts requires that the sac of the cyst be completely removed. If the cyst is squeezed and the discharge is forced out without removing the sac, the cyst will return. Usually, a doctor will be able to remove the cyst by making only a small incision in the skin. Antibiotics may be prescribed to treat infected cysts.
Lipomas are subcutaneous soft tissue tumors that usually are slow-growing and are harmless. They have a soft, rubbery consistency. Lipomas tend to form on the trunk, shoulders, neck, but can appear elsewhere on the body.
Lipomas can appear as solitary nodules or in groups. Most lipomas are less than 5 cm in diameter and have no symptoms, but they can cause pain when they compress nerves.
Lipomas are not removed unless there is a cosmetic concern, a compression of surrounding structures, or an uncertain diagnosis. Lipomas generally do not infiltrate into surrounding tissue so they can be removed easily by excision.
An alternative to standard excision is to manually squeeze the lipoma through a small incision. This technique is useful in areas with thin dermis, such as the face and extremities. Liposuction-assisted lipectomy also can be used to remove large lipomas with minimal scarring.

A carbuncle is a skin infection that often involves a group of hair follicles. The infected material forms a lump, which occurs deep in the skin and may contain pus.
Most carbuncles are caused by the bacteria staphylococcus aureus. The infection is contagious and may spread to other areas of the body or other people.
Carbuncles may develop anywhere, but they are most common on the back and the nape of the neck. Men get carbuncles more often than women.
You are more likely to get a carbuncle if you have:

  • Friction from clothing or shaving
  • Poor hygiene/ Dermatitis
  • Diabetes / Poor overall health/ weak immune system

It may also:

  • Grow very fast
  • Have a white or yellow center ( contain pus)
  • Weep, ooze, or crust
  • Spread to other skin areas
  • Fever
  • General discomfort or sick feeling
  • Skin itching before the carbuncle develops

 A sample of the pus may sent to a lab to determine the bacteria causing the infection, and help to start specific antibiotic
Carbuncle is surgically excised, pus drained and postoperative antibiotic  and painkiller are adviced.

A hydrocoele is the collection of fluid in the membranes surrounding the testicles, causing swelling in the scrotum. Hydrocoele can be present since birth or may develop any time after that or may occur later in life as a result of inflammation or injury to the testicles.

Hydrocoele are a common cause of scrotal swelling and do not cause any damage to the testes.  A hydrocoele can occur on one side or on both sides of the scrotum.

In children, hydrocoele may be the result of the passage through which the foetus’s testicle descends from the abdomen to the scrotum not sealing off properly (patent processus vaginalis), allowing fluid to flow from the abdomen into the scrotum.

Diagnosis of hydrocoele is usually by clinical examination. Further diagnostic tests such as blood tests and ultrasound scanning may be recommended.

Hydrocoeles are  usually not painful but may cause discomfort if they are large.

In infants, most hydrocoeles resolve without treatment by the age of one year. If the hydrocoele persists for longer than 18 months, treatment is usually recommended.

In adolescents and adults treatment may not be required if the hydrocoele is small, the testes can be examined easily, and the amount of fluid remains constant. Treatment is recommended if the hydrocoele is causing discomfort or embarrassment.

A hydrocoele can be treated by draining the fluid by a minor surgical procedure. This surgical procedure  performed on a day stay basis. In infants a general anaesthetic is used. In adults a regional anaesthetic may be used.

Lymph nodes

Lymph nodes are found throughout our body. They are an important part of our immune system. Lymph nodes help our body recognize and fight germs, infections, and other foreign substances. The lymph node can enlarge in case of disease. Enlargement of one or more lymph nodes can occur at one or multiple sites in body
Common areas where the lymph nodes can be felt are:

  • Groin
  • Armpit
  • Neck (there is a chain of lymph nodes on either side of the front of the neck, both sides of the neck, and down each side of the back of the neck)
  • Under the jaw and chin
  • Behind the ears
  • On the back of the head

Infections are the most common cause of swollen lymph nodes. Infections that can cause them include:

  • Abscessed or impacted tooth
  • Tuberculosis
  • Ear infection
  • Gingivitis
  • Sexually transmitted illness
  • Tonsillitis
  • Skin infections

Immune or autoimmune disorders that can cause swollen lymph nodes are:

  • HIV
  • Rheumatoid arthritis

Cancers that can cause swollen lymph nodes include:

  • Lymphomas - Hodgkin's disease, Non-Hodgkin's lymphoma
  • Secondaries from cancer
  • Leukemia

Certain medications can  also cause swollen lymph nodes such as:

  • Seizure medicines such as phenytoin
  • Typhoid immunization

Which lymph nodes are swollen depends on the cause and the body parts involved. Swollen lymph nodes that appear suddenly and are painful are usually due to injury or infection. Slow, painless swelling may be due to cancer or a tumor.
Painful lymph nodes are generally a sign that your body is fighting an infection. The soreness usually goes away in a couple days, without treatment. The lymph node may not return to its normal size for several weeks.
Consult the doctor if:

  • Lymph nodes that do not get smaller after several weeks or continue to get larger.
  • They are red and tender.
  • They feel hard, irregular, or fixed in place.
  • You have fever, night sweats, or unexplained weight loss.
  • Any node larger than 1 centimeter in diameter.

The following tests may be done:

  • Blood tests, including CBC, ESR, liver function tests, kidney function tests. 
  • Lymph node  FNAC / biopsy
  • Chest x-ray

Breast lumps
Breast lumps are broadly categorized as
Fibroadenoma: They are the most common breast tumor in adolescent women but may occur in menopausal women aswell. Their incidence declines with increasing age, and, in general, they appear before the age of thirty years. Fibroadenomas are partially hormone-dependent and frequently regress after menopause.
Higher intake of fruits and vegetables, higher number of live births, use of oral contraceptives and moderate exercise are associated with lower frequency of fibroadenomas.
Excision of the lump is the cure.
Fibroadenosis- Fibroadenosis is diffuse lumpy feel of the breast which may be painful and tender. It usually affects both breasts. It may increase with periods . Treatment is usually  bymedication. Rarely it requires a surgical treatment
Cancer/malignant of breast- it is one of the most common and also easily treatable cancer in women. It has a  good outcome if detected early. It can be diagnosed by needle biopsy, Mammography and ultrasound. Early cancers are treated first by surgery followed by chemotherapy or radiotherapy or hormonal therapy alone or in combination. Late stages may first require chemotherapy followed by surgery.

Pilonidal Sinus & Abscess
A pilonidal sinus is a depression in the skin  that occurs at the bottom of the tailbone (coccyx) and can become infected and filled with pus. Once infected, it is termed as pilonidal abscess. Pilonidal abscesses look like a boil at the bottom of the tailbone, just above the crack of the buttocks.
Pilonidal means "nest of hair" because hairs pierce the skin and collects inside the skin where it acts as a foreign body and initiates inflammation and subsequently infection
Pilonidal sinus causes pain at the bottom of the spine, swelling at the bottom of the spine,redness at the bottom of the spine,draining pus and fever
Early in an infection of a pilonidal sinus, the redness, swelling and pain may be minimal. Sitting in a warm bath may decrease the pain and may also decrease the chance that the sinus will develop to the point of requiring incision and drainage.
The preferred treatment  for  pilonidal sinus is incision and drainage of the sinus, removing the hair follicles, and packing the cavity with gauze.
Advantage - This is a simple procedure.
Disadvantage - This requires frequent changing of the gauze packing until the sinus heals, which sometimes takes up to three weeks
Another option is incision and drainage with immediate closing of the wound.
Advantages - The wound is completely closed immediately following surgery without the need for gauze.
Disadvantages - There is a high rate of recurrence.
A complete cure is possible, but a pilonidal sinus may reoccur. Even if surgically removed, the sinus may return.


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