Lumps And Bumps

Question 1

What are the steps to aspiration of a ganglion cyst?

Answer 1

1. Obtain informed written consent
2. Hand hygiene and don appropriate PPE
3. Pre-injection IPA swab
4. Subcutaneous LA injection - over the dorsal aspect of the lesion
5. Needle is inserted into ganglion and plunger is slowly pulled back to remove fluid
6. Needle is withdrawn - some residual fluid is often left, this can be expressed using gentle digital pressure around the lump
7. Some practitioners inject a corticosteroid at this point, however this is optional

Question 2

What is the main course of treatment for an epidermal/inclusion cyst?

Answer 2

Surgical excision

Question 3

What is an epidermal/inclusion cyst?

Answer 3

A benign encapsulated sub-epidermal nodule filled with keratin material, occurring when epidermal tissue is implanted into the dermis

Question 4

What can cause an epidermal/inclusion cyst?

Answer 4

Occlusion of a pilosebaceseous unit or of an eccrine duct

HPV infection

Surgical or traumatic implantation of the epidermis

Question 5

What are some DDX for an epidermal cyst?

Answer 5

Bursa/ Bursitis

Heloma Durum

Verruca

Rheumatoid Nodule

Question 6

What is a Mucoid cyst?

Answer 6

Benign dome shaped fluid filled sac caused by soft tissue swelling of the toe - similar to ganglion cyst

Commonly occurs on the DIPJ on the toes

Question 7

What is the common surgical treatment for a Mucoid cyst?

Answer 7

Surgical excision followed by fusion of the underlining joint to prevent reoccurrence

Question 8

What 8 things should you consider when a patient presents with an unknown growth?

Answer 8

Size

Location

Sponginess

Motility

Trauma - Was there any inciting trauma?

Growth rate - How fast has it grown?

Duration - How long has it been there?

Medical History - Any co-existing conditions that are associated with cyst/tumour/bone growth (I.E RA, OA, neurofibromatosis) or any familial or personal history