Mr Sanjay Purkayastha
BSc MBBS MD FRCS
Laparoscopic, General and Bariatric Surgeon
Private Medical Care:
General & gastroenterological surgery
Bariatric / weight loss surgery
Emergency abdominal conditions / surgery
In most of the cases, the diagnosis is clear on clinical examination and no investigations are required. In exceptional cases, malignancy may be suspected, in which case, further imaging, excision and histology are required to confirm the diagnosis. Most of the lesions does not cause any problem, however, if they present with symptoms like pain, discomfort or embarrassment, they can be surgically removed under local anaesthetics.
These can be defined as circumscribed, well-defined congenital lesions, also known as naevus. They appear and evolve from the age of 2 years up to 60 years. They are more common on the head, neck and trunk. Only very rarely do they undergo malignant change. There is a great deal of variability in size, shape and amount of hair present.
These are small flesh-coloured or brown growths that hang off the skin. They are found in approximately 25% of people and the numbers increase with age and obesity. They are frequently found in areas where friction occurs, eg the neck, axillae (armpits) and inguinal (groin) region. They are treated for cosmetic reasons or because of irritation. They are of no pathological significance in adults and not associated with any serious condition.
Warts are small lumps that often develop on the skin of the hands, feet, genital and anal area. They vary in appearance and may develop singly or in clusters. Some are more likely to affect particular areas of the body. For example, verrucas are warts that usually develop on the soles of the feet. Warts are non-cancerous, but can resemble certain cancers. Most people will have warts at some point in their life. They tend to affect children and teenagers more than adults. They are caused by an infection with the human papilloma virus (HPV). The virus causes an excess amount of keratin, a hard protein, to develop in the top skin layer (epidermis). The extra keratin produces the rough, hard texture of a wart. They are not considered very contagious, but can be caught by close skin-to-skin contact. The infection can also be transmitted indirectly from contaminated objects or surfaces, such as the area surrounding a swimming pool. You are more likely to get infected if your skin is wet or damaged. After you become infected, it can take weeks or even months for a wart or verruca to appear. Most types of warts are easy to identify because they have a distinctive appearance. A doctor should review it if it bleeds, changes in appearance, spreads locally or causes significant pain, distress and embarrassment.
Most warts are harmless and clear up without treatment.
The length of time it takes a wart to disappear will vary from person to person but it may take up to 2 years.
It usually warrants treatment, if it is painful, or occurs in an area that is causing discomfort or embarrassment, such as anal region.
Common methods of treatment include, salicylic acid cream, cryotherapy (freezing the skin cells), duct tape, chemical treatments and surgical removal.
They are the most commonly seen skin lumps. They may occur anywhere on the body, are made up of fat cells (adipocytes) and have a firm rubbery consistency. They usually do not cause any problems, although may cause symptoms due to mechanical pressure on underlying structures such as nerves. Removal is required for cosmetic and symptomatic reasons. Lipomas, which occur on the thigh and are very large in diameter, should be referred for specialist opinion to rule out involvement of cancer (liposarcoma).
These are round cysts filled with keratin, which is a protein produced by skin cells that gives strength and flexibility. The cyst communicates with the skin through a small round keratin-filled plug. The term sebaceous is a misnomer, as the sebaceous (oil producing) glands do not form any part of the lesion. They range in size from a few millimetres to several centimetres and commonly occur on the face, back and chest.
Rupture of the cyst wall commonly occurs resulting in an inflammatory reaction.
They may be removed either because of recurrent infection, or because of their appearance. They may either be removed intact, or by expressing the contents of the cyst through a small incision and then removing the cyst wall. The vast majority of these cysts are of no great consequence but some in certain places are a cause for concern.
Most often they present as a painless skin lump. They may present with discharge of a foul cheese-like material. If they become infected, they are red, inflamed and painful. Lesions of the genitals can be painful during intercourse and cause problems with walking or wearing underwear. They can also interfere with urination.
Most people with a cyst never seek medical attention and not require it to be removed. If the cyst is troublesome or if the patient is eager to have it removed, then it can be excised as a surgical procedure, mostly under local anaesthetics. In the operation the entire cyst wall is removed to avoid recurrence. If the cyst is red and hot it is probably infected. It is initially treated with antibiotics. In some cases, antibiotics treatment may fail and the infection progress to formation of collection of pus (abscess), which is drained as a surgical procedure.
An abscess is a collection of pus. Pus is a thick fluid that usually contains white blood cells, dead tissue and germs (bacteria). The usual cause of an abscess is an infection with bacteria. Certain bacteria are more likely to be 'pus-forming' as they make chemicals (toxins) that can damage the body's tissues. The infection causes the immune system to activate white blood cells and chemicals to fight the bacteria. In this 'battle' some tissue dies. A cavity forms and fills with pus. The cavity becomes bigger if the infection continues.
Where do abscesses form?
Most abscesses form just under the skin. A boil is the most common example. In this case, a hair root becomes infected and develops into a small abscess. A gland just below the skin at the entrance to the anus can get infected and develop into perianal abscess. The symptoms of a skin abscess include swelling, redness, pain and warmth over the affected area.
Who gets abscesses?
Most skin abscesses occur in people who are otherwise well. There is often no underlying cause, and no further problems usually occur once it has gone. Abscesses tend to occur more often in people with diabetes. Recurring skin abscesses may be the first indication of a problem with one’s immune system.
What is the treatment for an abscess?
Medicines called antibiotics are usually prescribed and the pus usually needs to be drained away. This involves a small operation to cut the top of the skin and allow the pus to drain. A scar will form as the skin heals.
What would happen if an abscess were not treated?
A skin abscess would normally eventually burst on to the skin surface and let out the pus. This may be after it becomes larger and more painful. So, antibiotics and surgical drainage are usually best. However, a small boil may burst and heal without treatment.