Found a lump under your skin? What a surgeon looks for, and when to get it checked

Found a lump under your skin? What a surgeon looks for, and when to get it checked

In brief: many lumps under the skin turn out to be something common, such as a cyst or a lipoma. But a lump's story often tells me more than its size. Here's what I ask, what I feel for, and when it's worth seeing your GP.

You're in the shower, or getting dressed, and your fingers find something that wasn't there before. Or perhaps it has been there for years, and you've only now started to wonder about it. Either way, it's natural to want to know: does this matter?

I'm a consultant surgeon, and lumps are one of the most common things people ask me about. This article explains how I think about them.

Why a lump's story matters more than its size

When I teach medical students, I tell them that examining a lump once is like looking at a single photograph. The patient's history is the whole film.

Two lumps can feel almost identical under my fingers and mean very different things. A soft lump that has looked the same for fifteen years tells me something quite different from one that appeared two months ago and seems to be growing.

So before I examine anything, I ask three questions:

1. How long has it been there?

2. Has it changed? Is it bigger, smaller or a different shape?

3. What worries you most about it?

The third question surprises people, but it often matters most. Very often the real question is, "Could this be cancer?" Saying that out loud early means I can explain my thinking properly: what reassures me, what I'm not yet sure about, and what we would do to find out.

I'll also ask what the lump does. Does it get sore, red or hot? Does it flare up and settle again? Has anything ever come out of it? Those details point me towards some causes and away from others.

Common causes of lumps under the skin

The NHS lists several common causes of lumps on the body, including:

• Lipomas: soft, movable lumps of fatty tissue

• Skin cysts: smooth lumps just under the skin

• Skin abscesses: swollen, painful collections of pus, sometimes with a high temperature

Less commonly, a lump can be something that needs prompt attention, which is why the warning signs later in this article matter.

Cyst or lipoma? What I feel for

Cysts and lipomas are two of the lumps I see most often, and they usually feel quite different.

A lipoma is a soft lump of fatty tissue. It usually sits just under the skin, feels soft and slightly doughy, and tends to slip under my fingers when I press gently.

A skin cyst is a small sac under the skin, filled with material the skin produces. It usually sits closer to the surface and is often attached to the skin above it. Sometimes there's a tiny dark pore in the middle, which people are often surprised to notice for the first time.

When I examine a lump, I'm asking: where does it sit, in the skin or beneath it? Is it soft or firm? Does it move freely, or does it feel fixed to something deeper? Is it tender?

My hands can tell me a lot, but not everything.

They can't always tell how deep a lump goes or what it's sitting next to. That's when an ultrasound scan can help, and it's something I'll write about next week.

If you'd like to read more, I've written in more detail about cysts and lipomas.

Does a painless lump mean it's nothing?

This is one of the questions I'm asked most often. It's an understandable belief: pain feels like a warning sign, so no pain feels reassuring.

But pain isn't a reliable guide on its own. Some harmless lumps, such as an inflamed cyst, can be very painful. And some lumps that do need attention are painless, particularly at first. Rather than pain, I pay attention to the story. Is it new? Is it changing? Does it feel hard, or fixed in place?

A lump you've had for years that suddenly starts behaving differently deserves a look too. I explain why in Why you should not ignore an old lump with a new symptom.

When to see your GP

The NHS advises seeing a GP if:

• your lump is getting bigger

• your lump is painful, red or hot

• your lump is hard and doesn't move

• your lump lasts more than two weeks

• a lump grows back after it has been removed

• you have a lump in your breast or testicle

• you have a swelling in your neck, armpit or groin that doesn't go down

If you're unsure, it's always reasonable to get a lump checked. You're never wasting anyone's time by asking.

Should a lump be removed?

Not every lump needs to come out. A lipoma that hasn't changed and isn't bothering you can often be left alone, with a clear idea of what change would be a reason to look at it again.

Removal can make sense when a lump:

• is painful, or keeps becoming inflamed or infected

• is growing or changing

• catches on clothing, a bra strap or a belt, or gets in the way day to day

• bothers you for cosmetic reasons

• needs a definite diagnosis

Most cysts and lipomas can be removed under local anaesthetic, so you stay awake and the area is numb. Where it's clinically appropriate, the lump is sent to a laboratory to be examined under a microscope, which confirms exactly what it was.

Part of my job is helping you decide whether removing a lump is worthwhile for you, not just whether it's possible.

If you're weighing up where to have a lump assessed and removed, my article on skin lump assessment and removalexplains what a surgical consultation involves.

Referred to a breast clinic?

Alongside minor surgery, I'm a breast surgeon, and I know how hard the wait for a breast clinic appointment can be.

Most breast clinics use a "triple assessment": an examination, imaging (people under 40 are more likely to have an ultrasound than a mammogram) and, if needed, a needle biopsy. You may be there for several hours, and you can usually bring someone with you. Most people seen at a breast clinic do not have breast cancer.

Breast Cancer Now has a clear guide to what happens at a breast clinic appointment.

Getting a lump checked at SML Surgical Care in Ware

If you'd like a lump looked at, our clinic on East Street in Ware offers consultations for lumps, cysts, lipomas, moles and other skin lesions. A consultation starts with your story and an examination. For deeper lumps, cysts or lipomas, we also offer a consultation that includes an ultrasound scan.

You'll leave with a clear plan, including when nothing needs doing.

You can book online at sml.surgery/book-online, call us on 01920 455522, or email info@sml.surgery. You can find more about the procedures we offer on our Minor Surgeries page.

This article is general information and isn't a substitute for advice about your own symptoms. If you're worried about a lump, please speak to your GP or arrange a consultation.