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Patient Advice and Information

Skin Moles, Sebaceous Cysts & Dermofibroids, and Lipomas
by Dr Panayiotopoulos, Consultant Vascular and General Surgeon Essex.

A. Skin Moles

1. What are the skin moles?

The most common of benign skin growths are moles [nevi] which come in different sizes, shapes, colours and types. There may be just one or two, or a lot scattered over the body [more common at the back, called vilitigo].

They also have a strong hereditary occurrence.

Moles may be pigmented [coloured] or non-pigmented. In pigmented, the colour may vary from light tan to black.

It is important to distinguish simple moles from other skin growths like papillomas [skin tags], warts and keratoses. Most of these benign skin growths are cosmetic problems or cloths-catching nuisances.

2. Why people say that moles may be dangerous?

Some melanomas [skin cancer] may present like skin moles and sometimes it is difficult to differentiate them. When a mole is dark blackish, elevated and rough in appearance, it may be a melanoma. The ABCD rule can be used for differentiation:

·         Asymmetry: most moles are symmetrical and round.

·         Border: Most moles have even borders.

·         Colour: Most moles have a uniform brown colour. Elevated and black ones may be melanomas.

·         Diameter: Most moles are small, about 6mm or smaller. They also do not grow fast.

3. When should I be concerned about my skin moles?

If any of the conditions described above exist, then the first thing you should do is a visit to your family doctor. More likely you would be advised to do nothing or to wait and watch and have periodic re-checks. When there is any question your doctor will recommend excision biopsy.

4. When and how should moles be removed?

The indications for removal are cloth-catching and bleeding or or when a mole is changing or issuspicious for malignancy.

Surgery is performed under local anaesthesia and can usually be done in the doctor’s office.

The local anaesthetic is injected beneath and around the mole with a syringe. You will feel the initial scratch and then you may feel a burning sensation , but soon the area becomes numb.

The mole is then completely excised with a scalpel [shaving biopsy] or it is removed through an elliptic skin incision. While the shaving biopsy is left as it is, the block excision wound is usually stitched.  The specimen is sent for histopathology and the wound is covered with an airstrip.

5. What about after surgery?

·         The wound can be exposed within 24-48 hours and, depending on the site, you will carry on your normal activities.

·         If there are any stitches to be removed, they are removed in 4-7 days.

·         Most patients need no pain killers follwing this type of surgery.

·         As with any surgical procedure, bleeding and infections are probably the more common complications, but the risk is minimal If the wound bleeds during the first 24hours, press a clean tissue or cloth to it for 10minutes. It will stop in almost all cases.

·         A hard ridge will form along the incision in 24-48 hours, but it will recede gradually as it heals.

·         If you have incisional pain, application of heat [heat lamp or warm compress] will relieve it.

·         You should bathe and shower as usual after 48 hours. Between baths you should keep the wound dry, with or without a dressing.

·         You should call your doctor if:

-    Pain, swelling, redness, drainage or bleeding increases in the operation site.

-    You develop signs of infection

If a shaving biopsy has been performed and histology shows that it is a benign mole, nothing further is    needed, even if some mole tissue is left behind.

However, if it was found to be an atypical mole [dysplastic naevus], then further excision biopsy is recommended. In such a case, your doctor will inform you to attend for further excision, again under local anaesthesia.

B.  Sebaceous Cysts & Dermofibroids

1. What is a sebaceous cyst and a dermofibroid?

Sebaceous cyst is a slow growing benign tumour of the skin containing follicular, keratinous and sebaceous material. The are often characterised by a small black or white formation in the skin pores. Dermofibroids look like the cysts but contain fibrous material. They are more common then sebaceous cysts. However, treatment is not much different.

These lumps occur into the skin and they are usually found in the scalp, behind the ears, face back or srotum. They are firm, globular, movable and non tender. They seldom cause discomfort, unless the rupture or get infected.

They are usually small in size but may become quite big. They occur at any age, but usually arise in adulthood as they are rare in children. 

They represent slowly growing or stationary lumps..

2. What causes these lumps?

The aetiology is mostly unknown. Blockage of the sweat glands by accumulated keratin into the duct [as they are mostly found in apocrine gland areas and in people who do not rub themselves well when having a bath] has been proposed but is not widely accepted. Trauma may also play some role in forcing some of the epidermis into the dermis [inner skin layer].

3. Is there any treatment?

Surgery is the only recommended treatment but is optional in non-complicated cysts.

The indications are presence of symptoms, cosmetic appearance, prevention of infection, and cloth-catching nuisance.

4. How are the cysts removed?

Surgery is usually performed under local anaesthesia.

The local anaesthetic is injected on the incision line and around the cyst with a syringe. You will feel the initial scratch and then you may feel a burning sensation, but soon the area becomes numb.

The skin incision is then performed over the skin with care taken not to rupture its confining wall. Leakage from the cyst can cause inflammation and delay healing. Sometimes an elliptic skin incision is used to guarantee intact removal and provide better cosmetic result by removing the redundant skin. Ever effort is made to remove the cyst intact.

The wound is then stitched by removable stitches, although dissolvable stitches may be used.

The wound is covered with an airstrip.

The specimen is not sent for histopathology

There is no need for antibiotics, however, they will be prescribed if the cyst was infected.

5. What about after surgery?

·         The wound can be exposed within 24-48 hours and, depending on the site, you will carry on your normal activities.

·         If there are any stitches to be removed, they are removed in 4-7 days.

·         Most patients need no pain killers follwing this type of surgery.

·         As with any surgical procedure, bleeding and infections are probably the more common complications, but the risk is minimal [1-2%]. Recurence of the cyst [rare] if the cyst wall was not completely removed.

·         If the wound bleeds during the first 24hours, press a clean tissue or cloth to it for 10minutes. It will stop in almost all cases.

·         A hard ridge will form along the incision in 24-48 hours, but it will recede gradually as it heals.

·         If you have incisional pain, application of heat [heat lamp or warm compress] will relieve it.

·         You should bathe and shower as usual after 48 hours. Between baths you should keep the wound dry, with or without a dressing.

·         You should call your doctor if:

-   Pain, swelling, redness, drainage or bleeding increases in the operation site.

-   You develop signs of infection

C.     Lipomas

1. What are lipomas?

Lipomas are benign tumours composed of mature fat cells. They differ from normal fat biochemically, plus the fact that they may contain other tissue, like muscle cells or capillaries [angiolipoma, which may be painful].

They usually occur under the skin [back and neck are the commonest sites] but they may be found in deeper tissues and even in various organs.

They usually present with little difficulty in diagnosis, as they develop as discreet rubbery [the skin overlying the lump is normal and is not connected to it] and slightly mobile lumps in the subcutaneous tissues. They are usually a few centimeters in size but may become quite big. They occur at any age, but usually arise in adulthood as they are rare in children.

They represent slowly growing lesions present for several years. There is usually no complaint of discomfort.

Solitary lipomas are more common in women, while multiple ones occur more frequently in men.

2. What causes lipomas?

There is no known cause of lipoma formation. Diet [high cholesterol and animal fat] obesity and lack of exercise have been mentioned as aggravating factors, but nothing is proven. Certainly, localised lipomas and “lipoma like” diffuse collections are more common in overweight individuals.

3. Is there any treatment?

Surgery is the only recommended treatment.

The indications are presence of symptoms, cosmetic appearance, cloth-catching nuisance and the clinical concern about possible malignancy [liposarcoma], although rare. If the lump is not rubbery and seems to arise underneath the subcutaneous tissues [below the fat that covers the muscles], the possibility of cancer should be considered. In such a case a biopsy [tru-cat needle core biopsy] is indicated before your doctor attempts removal.

4. How are lipomas removed?

Surgery is performed under local anaesthesia, but general anaesthesia may be required, especially for large lipomas.

The local anaesthetic is injected at the incision line and around the lipoma with a syringe. You will feel the initial scratch and then you may feel a burning sensation, but soon the area becomes numb.

The skin incision is then performed, the lipoma is dissected free and is completely excised. Sometimes an elliptic skin incision is used to provide better cosmetic result by removing the redundant skin. The wound is then stitched by dissolvable stitches, although removable stitches may be used in areas where skin is thick [back].  The specimen is sent for histopathology and the wound is covered with an airstrip.

5. What about after surgery?

·         The wound can be exposed within 24-48 hours and, depending on the site, you will carry on your normal activities.

·         If there are any stitches to be removed, they are removed in 4-7 days.

·         Most patients need no pain killers following this type of surgery.

·         As with any surgical procedure, bleeding and infections are probably the more common complications, but the risk is minimal [1-2%].

·         If the wound bleeds during the first 24hours, press a clean tissue or cloth to it for 10minutes. It will stop in almost all cases.

·         A hard ridge will form along the incision in 24-48 hours, but it will recede gradually as it heals.

·         If you have incisional pain, application of heat [heat lamp or warm compress] will relieve it.

·         You should bathe and shower as usual after 48 hours. Between baths you should keep the wound dry, with or without a dressing.

·         You should call your doctor if:

-    Pain, swelling, redness, drainage or bleeding increases in the operation site.

-    You develop signs of infection

·         You will be informed about the histology at the outpatient visit, when the doctor will inspect the wound.

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Please note:
A written referral from a general practitioner is helpful but is not essentially required in order to make an appointment to see a consultant specialist.

 
 

This page was last updated on 01/10/2006

Vascualr surgeon for varicose veins, renal and general surgical conditions and procedures