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A lump under the skin
Cyst, lipoma or something else: how they are told apart and which signs should not wait.
It is almost always noticed by chance, with the hand: a rounded swelling under the skin that was not there before. The most common reaction is to search online, and the result is nearly always the same — dozens of possibilities, from the most ordinary to the most frightening, with no criterion for choosing between them.
The criterion does exist, and it is largely tactile. A cyst is attached to the skin, moves with it, and very often has a small dark pore at its centre — the point it originates from. A lipoma sits deeper: it is soft, yielding like dough, slides under the fingers, and the skin above it moves freely. A lymph node is found in specific sites — neck, armpits, groin — and often appears or enlarges in relation to an infection. They are three different things, with different paths. This matters because what people call a fatty lump may be either: the common name covers both the lipoma and the cyst, and telling them apart is done by touch, not by the name.
There are also features that, whatever the hypothesis, move the visit to the top of the list: a lesion that grows quickly, that is hard rather than soft, that does not shift because it seems fixed to the deeper planes, that hurts on its own, or that alters the skin above it. They do not automatically mean something serious, but they are exactly the characteristics it makes no sense to assess alone.
The rest of the reasoning is not done by touch, and it should be said plainly: whatever is removed goes for histological examination. It is the laboratory that gives the definitive name, not palpation and not even the doctor's eye. This is why the correct sequence is always the same — first you look, then you decide whether to remove, and in every case you send it for analysis.
Hard, fixed or rapidly grown: the three features that should not wait
Most subcutaneous swellings are benign, and this page is not meant to suggest otherwise. It is meant to isolate the few features that warrant a visit without delay: hard consistency, inability to move it relative to the deeper planes, obvious growth over a matter of weeks, pain appearing on its own, alteration of the overlying skin. Any one of these is enough to book an appointment. None of them, conversely, licenses you to conclude on your own that all is well: it only means there is no reason to worry while waiting for the visit.
How it shows
- A rounded swelling appearing under the skin, often found by chance
- Soft and slippery, or firm and adherent: these are different pictures
- A small dark pore at the centre, typical of cysts
- Slow growth over months or years, or rapid growth over a few weeks
- Spontaneous pain, redness or warmth of the overlying skin
- A lesion that does not move relative to the underlying tissues
How we proceed
- 1Dermatological visit: site, size, consistency, mobility over the deeper planes
- 2Clinical distinction between cyst, lipoma and other pictures, which are not treated alike
- 3Assessment of whether and when to intervene: not everything needs removing, and timing matters
- 4Outpatient removal under local anaesthetic, where indicated
- 5Histological examination of what is removed, and a follow-up for healing
Available treatments
- Dermatology visit
- Assessment of the lesion
- Outpatient removal
- Histological examination
- Post-operative follow-up
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Frequently asked questions
How do I tell a cyst from a lipoma?+
By touch the differences are fairly consistent. A cyst is more superficial and moves with the skin: move the skin and it moves too, and a small dark dot is often visible at its centre. A lipoma sits below, is soft and yielding, slips away if pushed sideways, and the skin above moves freely. These are useful clues, not a diagnosis: definitive confirmation still comes from histology after removal.
Does it have to be removed?+
No, and this is one reason the visit is useful even to someone who has already decided to do nothing. Many benign, stable and untroublesome lesions can simply be kept under observation. The indication to remove arises when the lesion grows, hurts, becomes repeatedly inflamed, sits in an awkward place, or when there is doubt about its nature. In that last case the reason for the procedure is not cosmetic: it is to get an answer.
Is the procedure done in the clinic or does it need a hospital stay?+
Removing these lesions is an outpatient procedure under local anaesthetic: it is done on site, you go home straight afterwards, and the appointment is longer than a visit because it includes the procedure itself. Sutures and healing time depend on size and site. Particular situations of depth, size or position may require a different setting: in that case we say so at the visit, before scheduling anything.
Can I try squeezing it?+
It is the thing that most often makes matters worse. In cysts, squeezing empties the contents but leaves the wall in place, that is, the structure that will produce the same material again: the lump comes back, and meanwhile the manoeuvre can trigger inflammation or infection. An inflamed cyst is also harder to remove cleanly and leaves a worse result, so squeezing not only fails to solve it: it complicates the procedure that may be needed.
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