Nikki Sommer, a nurse with Key West Surgical Group, joined Good Morning Keys on KeysTalk 96.9/102.5 FM for Medical Matters this morning.
The doctors at Key West Surgical Group can help with different kinds of cysts and skin lesions, like lipoma.
Sommer said, “It’s like a collection of fatty tissue under the skin, and there’s really no rhyme or reason why it happens. Some people have a family history of them, and they can pop up anywhere on the body, like your arms, your trunk, your back, and they can grow fairly large. The majority of them can be done in the office and what happens is a lot of times they start to grow and they’re not, and I don’t want to say the word cosmetically pleasing, because it is a medical procedure and it’s covered by insurance, because they can grow really big. Usually they’re benign. There’s no cancer associated with them. They’re just, you can bump them or they stick out. I mean, we’ve had some patients that had big like bumps on their back that have come in and have it taken it out, and they’ve even had to take them to surgery to do it because they had gotten so big.”
They differ from sebaceous cysts.
Sommer said, “A sebaceous cyst is like a clogged hair follicle, you could compare it to, like a really large acne. They’re hard, kind of like a little mobile cyst. They’re filled with, like a cottage cheese, like substance. And again, they start out small, and what happens is a lot of people think it’s like a pimple, and they try to squeeze them and they make them worse. They grow bigger and then they can even get infected, because you have bacteria that lives on your skin and when you start squeezing and pushing on little lumps and bumps on your body, that bacteria can get underneath your skin and cause an infection. So then they become infected and they just get really red and angry and hard and hot and indurated. Sometimes they’re so inflamed that the fluid is trapped underneath them. So we’ll have to put you on antibiotics for a couple of days to get it to soften up and do hot compresses before they can be lanced, but this is something that can be done in the office, and it’s usually more of like an emergent, I need to get it done now type of thing, because the longer you wait, the bigger and worse they can become.”
How does cyst removal work?
Sommer said, “A lot of times, with either one of them, if they’re not infected, when they’re abscessed, they’ll cut them open, they’ll drain the pus and then pack it for a couple of days, possibly put your own antibiotics. Once it’s healed or if you have one that’s just bothersome, that’s not infected, it can be removed in the office. Basically, it’s under local anesthetic. There’s just a little lidocaine, it’s cleaned. Lidocaine is injected, a small incision is made, and especially with a sebaceous cyst, it comes out like a round, solid ball of that cottage cheese type substance. So when it it’s completely formed, it just pops, kind of like they’re able to pop it out and remove it, and then it is no longer an issue. Lipoma, it’s usually little globules of fatty tissue, and sometimes they can be round, and sometimes they’re really interesting, because it’ll feel like it’s not that big when you touch it, but it goes in deep, so it’ll come out deeper than expected. They are bigger than expected, but it’s little fatty globs of fatty tissue attached together.”
What’s a skin abscess?
Sommer said, “That’s usually an infected, and lipomas can be infected too, because people, when they first, especially if they’re smaller, they don’t realize that it’s a fatty tumor, and they think it’s a sebaceous cyst, and they squeeze on it and aggravate it and it gets infected. So that’s when it needs to be lanced and drained when, like there’s an accumulation of pus and infection under the skin.”
How does an abscess form?
Sommer said, “That’s when you have a cyst that becomes infected, either by scratching or popping, or the bacteria somehow gets under the skin and inflames the tissue and creates, like an abscess, creates pus to that area. A lot of times, people get infected hair follicles, especially if they shave, like a lot of men, that are hairy, some even when they shave their face, if the hair is really thick and coarse, it can form a an abscess. Women shaving their legs, their pubic area, a lot of times it’s common for women to get abscesses, or it’s called the folliculitis there that turns into infection, and it needs to be lanced. We’ve talked about pilonidal cysts before. That’s kind of like the cyst that forms on your tailbone. It’s kind of the same thing. It’s ingrown hairs. They grow inward, and the hair has bacteria on it, and it goes underneath your skin and it creates an infection.”
Sometimes an IND might need to be performed.
Sommer said, “That’s when they cut it open, they lance it with a scalpel and then they drain the pus. The pus just needs to get out. Sometimes you don’t need antibiotics if you catch it soon enough, but it’s just a matter of opening it and then they put a medicated wick, or an iodine based soap gauze that kills the bacteria. You pack it and it heals the secondary intention, which is from the inside out.”
Sometimes lesions can be suspicious, and sometimes they can have abnormal cells.
Sommer said, “Skin cancer can start to scab or flake, and people pick at it, they cause it to be infected. So what looks like an abscess, and then either it doesn’t heal, or it needs to be biopsied. We send it out, and we find out that it’s a skin cancer. We’ve talked about the different ways to remove suspected lesions. We can do that in the office as well.”
What are the types of skin lesion biopsies?
Sommer said, “There’s a couple of them. Sometimes dermatologists will refer to us because they have biopsied in their office and it comes back as skin cancer, so it needs a bigger portion removed because it’s in the margins. So they will come in to us and a lot of times it could be done in the office, if the area is small enough.”
A lot of skin issues can be as a result of sun exposure.
Sommer said, “We’ve talked about protecting your skin and getting regular skin cancer check. We see a lot of people that will come in for one thing, will say to her, hey, I have this spot. It’s bothering me. It’s flaky, it’s itchy. It just appeared. It’s a bump. It’s growing. She just removed her pretty, fairly large squamous cell um lesion off of a man’s leg that he said, he felt like it appeared overnight. It was probably something that was there and small, and then all of a sudden it began to grow rapidly, and it was a decent size, and she was able to take it off in the office, and it was squamous cell skin cancer. So we do see a lot of it and patients will come in even, like, follow up from either a colonoscopy or an endoscopy, and they’d be like, by the way, I have this lesion on my skin and she’d be like, oh, yeah, that looks suspicious. And she has to come back and take it off. We see that often.”
There are different types of skin lesion biopsies.
Sommer said, “The shave biopsy is an area where, like, they just take a razor or a scalpel, and they’ll take the cells from the top layer of the skin, and they send it out for pathology, and then the punch is another one, where if it’s kind of round, so they have this thing called a punch. It’s literally a circle, and she’ll numb the area. She punches it, and it kind of creates a circular area tissue that you can grab and pull and cut.”
There are also incisional and excisional as well.
Are there risks of getting a skin lesion biopsy?
Sommer said it’s “minimal risk, sometimes bleeding or post op infection, bruising. Every once in a while, somebody has, they’ll call it an allergic reaction. It could be to the steri-strip or the tape or what we use to dress it, post procedure, minimal risks for it. I would say bleeding, bruising and like post op infection, because you now have an open wound, so keeping it clean and dry, especially down here, where bacteria breeds, because it’s so hot is really important.”
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