Prakash Chandran (Host): From pesky skin tags to painful cyst and abcesses, our bodies can be quite the host for an intriguing array of lumps and bumps. But how do you know what they are and when to seek help from a professional? We're going to talk about it today with Athena Drosos, a Certified Physician Assistant and Wound Care Specialist at St. Joseph Hospital. Welcome to Wellness First, a St. Joseph Hospital podcast, where we hear and learn directly from the experts on all things health and wellness. I'm your host, Prakash Chandran. So, Athena, thank you so much for meeting with me today and joining us. I wanted to get started by asking what are the most common lumps and bumps that people come into the office with?

Athena Drosos, PA-C: Sure. So most people come in with either a blocked sweat gland called a sebaceous cyst, also known as an epidermal inclusion cyst, or a lipoma, like a little fatty lump. Usually it's been there for many years and it's bothersome to them and they want to get it removed either in the office if that's the option or in the OR.

Host: Got it. And then when you're saying they have like a blocked sweat gland, is that from exercise? Is that from lack of movement? Can you talk a little bit about that?

Athena Drosos, PA-C: Sure. So, it's actually quite random. So the sweat glands are all over our bodies. And it can happen usually, mostly on the trunk not really in the armpits and stuff like that, where you typically think of sweat glands, it's like on the back of the neck it can happen. And yeah, it's just, bad luck, I think, mostly.

Host: Totally. So how does like a blocked sweat gland, for example, manifest? Is there just like a red area on the body that people say like, Hey, this is a little abnormal. Maybe I should get this checked out.

Athena Drosos, PA-C: Yeah, so it'll be a firm, little, like, round or oval, sort of like raised area. So just slightly above the skin, it'll feel firm. Sometimes they slowly grow over the course of weeks to months. Sometimes people don't notice them until they're a certain size and then it just looks like skin color. Sometimes you'll notice a tiny little spot, like little dot on top of them. And that's actually the sweat gland that got blocked, which is actually how we diagnose it clinically in the office.

Host: Okay, I understand. Now, I've had stuff obviously show up on my skin before, like sometimes on my face, sometimes on my body. Sometimes it's nothing. Maybe it's a little tender to the touch, but it goes away over time. At what point do you say like, Hey, this is potentially something more serious that requires coming in and seeing someone like yourself?

Athena Drosos, PA-C: Basically when, it doesn't go away, when you're finally sick of it or if it becomes very painful. So, these sebaceous cysts, often people will come into the clinic and say, I've had this for six years, ten years, something like that.

Host: Oh,

Athena Drosos, PA-C: And either it's bothersome, like, Oh, I was hugging my grandmother and she felt it and she said I have to go get it checked out. Or it can become infected later on after having it for so long. And then you will definitely seek attention because it will be hot, painful. And some of them, if you don't go in fast enough, they'll come to a head like a pimple or something like that and really, really hurt.

Host: Okay, so, I know a lot of us might be like, Hey, I can self-treat one of these things at home, even if it has been there for a while. They may try to pop it. They may try to do the whole hot warm water. And I know you're, you're waving your finger me.

Athena Drosos, PA-C: Do not squeeze it. Don't pick. What did your grandmother tell you?

Host: Let's talk about why you should not try to self-treat.

Athena Drosos, PA-C: So, sebaceous gland material is thick. It's not like pimple that's very superficial. You can see almost right through the skin at the top of it where you, you know, whatever, shouldn't pop pimples anyways, but trying to squeeze something like that actually can drive infection into the skin and cause a worse cellulitis and things like that. So, A, it's not going to make it go away if it's not infected. And if it is infected, you can really worsen the infection if you try to squeeze and poke at it.

Host: Yeah, and most people don't have, like, sterile hands. They're just like, oh, I just ate lunch and now I'm going to try to pop this thing wherever it might be, right?

Athena Drosos, PA-C: Exactly. You come in, we'll do a sterile conditions and we'll take care of it. Hopefully before it's infected.

Host: So I want to talk about that piece of it. So, they come in there, maybe they decide, hey, maybe I shouldn't deal with this myself. They come in to you, talk a little bit about how you, number one, assess things, and then how treatment plan gets administered.

Athena Drosos, PA-C: Depending on what it is, if it's a skin lesion that's discolored, if it's a mole that was growing, if it's just like a lump or if it's a tiny little bump on the skin, the diagnosis is almost entirely made clinically. So we take a look at it, feel the firmness of it, get the history behind it, see if it's ever been infected, it's ever drained before, and if anybody has any symptoms from it. Often, luckily, they're actually asymptomatic and they're not infected. But we just have seen so many of them that we can diagnose it by just looking at it essentially, on a photo, but when you can really get your hands on it is when you can make the diagnosis.

Host: Yeah, and I think as I listen to this, it sounds like, and please correct me if I'm wrong, that the majority of the cases are something that are treatable, maybe with medication or obviously, through a professional like yourself, but I think the concern is always, is this cancerous? Is this something that is going to become something more serious that I potentially should have taken care of earlier? Can you speak to that?

Athena Drosos, PA-C: Yes, the things that we were talking about are treated with procedures. So there's no medication that you can take to unblock a gland and then make it go away entirely because basically the blockage has created a cyst cavity that you want to totally remove in order for it to never come back again.

But often people come in and they say, I have this thing. It's been there for a year. It seems to be growing. Like, what is it? Like, is it cancer? What is it? And, often we can tell right away, but sometimes we need to take a biopsy, you know, somebody comes in with a mole that has irregular borders, change in color, raised in certain areas, we would just take a biopsy of the corner of it, make a diagnosis before we try to remove it because things can be removed differently. Different kinds of skin cancer or in lesions have to be removed with different amounts of good skin around them in order to get what we call like negative border.

Host: So let's talk just about the removal process in general. I realize there's many different approaches depending on what a person has, but maybe talk about some of the modalities what someone can expect when they go in for removal and then also care and recovery time afterwards.

Athena Drosos, PA-C: I'll tell everybody basically the same thing when they come in. If we think that we can remove it in the clinic as in it's small enough, the patient's not on blood thinners and they're up for it, we can remove it in the clinic. And I tell basically everyone what we're going to position you. We're going to clean it. We're going to numb it. That's the worst part. Lidocaine burns. It stings. But then it's numb. And then we're going to remove it in its entirety. We're going to clean you up and we're going to sew you up. It changes if there's an infection. So if somebody comes in and things are grossly infected, the cyst cavity has already exploded, if you will, like it's not in one contained little package. It's already been disrupted in some way. So we will just make an incision, remove that central punctum is what that's called, that little spot where the sebaceous gland has been blocked. And then we will clean out everything that we can clean out. I'll take as much of the cyst wall out as possible.

We can't close the skin because then we'll just be closing possible infection back in. So then it's just a little wound that they have to take care of. But it's very basic wound care needs as in a dry gauze changed once a day or something like that. For somebody that comes in and it's not infected it's a little bit different, 90% of the time I'll say, I can put the sutures just underneath the skin so people don't have to come back to get sutures removed. It just dissolves in the skin and we put the little pieces of tape on there. And yeah, people don't have to actually come back unless there's results or something like that we need to see. But often, if I can tell that it's very benign when I take it out, we don't even need to send it to pathology.

Host: Okay, got it. Now, I'm sure you get people that come in that say, like, maybe there's absolutely nothing wrong with it. It's just this benign little lump on their body. They could actually just live without it. But they're like, actually, I just don't like the way that it looks. Is something that you can do for me? Do you see that often?

Athena Drosos, PA-C: Yeah, all the time. We can take those out too. What you're doing is you're just trading this little bump for a small incision, or a little scar you know, people scar differently. Most people just turns into a thin little line. Some people can get thicker scarring, if you will.

But yeah, you're trading the bump and the unknown and the possibility of it becoming infected later on in life with a small scar, which most people are totally fine with, but of course that's one of the risks. Bleeding, infection, damage to surrounding structures is the risk for any surgery you do, ever. Damage to surrounding structures, luckily, is almost nothing in the skin, because it's just skin deep, if you will.

Host: For sure. So, as we start to close the conversation, I just wanted to talk a little bit about potential prevention or maybe prevention of things getting worse. You've seen probably lots of different patients. Is there advice that you would give around like, hey, if you notice this type of lesion or this type of discoloration, maybe do something about it sooner? Anything or any advice you want to share with the audience?

Athena Drosos, PA-C: Some people are just prone to sebaceous cysts. Some people have had one in their life, and that's it. Some people have had like five in their lives, and that's, less lucky. But we're just showering and being normally clean, there's nothing really that you can do about it.

It's like I said, just unfortunate for some people. The lipomas can be familial. So, some people that come in that have like those little fatty lumps. That are just like usually a little bit bigger. Maybe, not too big, but the lipomas can be familial. So they would say like, oh, my dad has a million of them or like I am covered in them. This one is the one that bothers me because when I lean on it, it hurts. Just take this one out. Yeah, there's nothing that you could do to prevent it, unfortunately.

Host: Got it. And then the final piece is just around the exact steps that someone should take. So you said, like, generally someone might go to their primary care or a dermatologist to say, like, hey, I've noticed this thing and then that potentially gets escalated. Talk to us about, what would you like to see people do when something has been around for years and they want to do something about it?

Athena Drosos, PA-C: I think partially depends on insurance, but if you can self-refer, you can just self-refer to our clinic and we can see you, evaluate the area, the skin lesion, the bump, the lump, whatever it is and say, oh, this is benign, easy to take care of. We'll take care of it right now. Or maybe you need surgery. But often people will need a referral from their primary care doctor. And it's nice to actually bring up any of those little concerns to your primary care doctor early and just let, you know, some primary care doctors say, oh, it's benign, nothing to do about it. Don't worry. But if you don't like it and you want it removed, just say, I want a referral. It's that simple because it's unfortunate when somebody has had something for years, they say, oh, I've had this for years and I really wanted it taken care of, but it was benign.

So I didn't feel like coming out for it. And then when, by the time they see me, it's infected, it's really unfortunate, it's more painful, and also I can't close the skin nicely, you know, like the scar is going to be bigger. It's not as nice.

Host: Yeah, absolutely. So I think an important piece is just be mindful, take control of your own health. If it is something that you want removed, you can just ask directly for a referral or self- refer, and you'll be able to take care of them.

Athena Drosos, PA-C: Absolutely.

Absolutely.

Host: Awesome. Well, Athena, this has been super informative. Thank you so much for your time today.

Athena Drosos, PA-C: Thank you.

Host: That was Athena Drosos, a Certified Physician Assistant and Wound Care Specialist at St. Joseph Hospital. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

I'm Prakash Chandran and this has been Wellness First by St. Joseph Hospital. Thank you so much for listening.