Lump under the skin
Round or oval, mobile, skin-colored or yellowish-white; from a few millimeters to a few centimeters.
CONDITION / FACE
Atheroma of the face, behind the ear and on the lobe.
Atheromas of the face are spherical bumps under the skin, filled with horny substance: epidermoid and tricholemal cysts. They are benign, but can become inflamed; the most reliable way to get rid of a cyst is to remove it together with the membrane.
CONCEPTUAL VISUALIZATION- What it is
- A benign cyst under the skin with a thin membrane, filled with keratin - a horny substance.
- Where it happens
- Most often on the face, scalp, neck and upper body; near the ear - mainly epidermoid cysts.
- What bothers
- A bump in a prominent place, discharge with a smell, repeated inflammations.
- Which helps
- Removal together with the shell; the inflamed cyst is treated first.
01 / WHAT IS ITWhat is
What is
atheroma
"Atheroma" in Ukraine is often called a spherical bump under the skin - both in everyday life and in many clinics. This word usually refers to two different cysts: epidermoid, which is also called infundibular (it is formed from the watering can of the hair follicle), and tricholemal, or pilar, growing from the shell of the hair follicle.
Both have a thin shell and are filled with keratin, a horny substance, not sebum. Therefore, the old name "sebaceous cyst" is inaccurate. An epidermoid cyst often has a dark spot in the center — an outlet through which it communicates with the surface of the skin. Tricholemal often grows on the scalp.
Atheroma grow slowly and may not bother you for years. They are not cancerous and are not contagious. Cancer in such a cyst is rare: 56 cases of squamous cell carcinoma arising in an epidermoid cyst have been described in the English-language medical literature.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
atheroma presents.
An atheroma is a bump that can be seen or easily felt under the skin. As long as she is calm, she does not hurt; it starts to bother you when it becomes inflamed or presses on neighboring tissues.
A dark spot
In the center of an epidermoid cyst, a small dark dot is often visible - an opening leading into the cyst.
Content with smell
Sometimes a whitish mass with an unpleasant smell is released from the hole - it is keratin, which is filled with the cyst.
Inflammation
The cyst suddenly becomes painful, red and swollen. Often the cause is a rupture of the membrane, and it is not always an infection.
On the lobe and near the ear
Lumps around the ear are most often found to be epidermoid cysts: on the lobe, in front of the ear, behind the ear, and in the ear canal.
Torn earlobeOn the head
A tricholemal cyst is dense: in a series of 54 such cysts, 68% were on the scalp, and 65% had calcifications inside.
03 / REASONSWhy does it appear?
Why does it appear?
atheroma
The exact cause of cysts is often unknown. This increases the probability of its appearance.
Clogged follicle
An epidermoid cyst often forms from a hair follicle when it becomes blocked or ruptured.
Skin injury
Cells on the surface of the skin can go deep during an injury or medical manipulation and form a cyst there.
Heredity
Cysts are more common in people whose relatives also have them - especially tricholemal cysts.
Age, gender, acne
More often — in adults, especially in middle age, in women and in people with acne.
Congenital cysts
Rarely, the cyst is congenital: skin cells are deep inside before birth. Such cysts lie along the lines where facial tissues grow.
Dermoid cysts of the face
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Calm atheroma does not require emergency care. But an inflamed cyst on the face can cause a skin infection that spreads, in particular to the eye socket. Call 103 if at least one of the following appears against the background of an inflamed cyst or redness around it:
103 immediately if:
- very high temperature, fever or severe chills;
- rapid pulse or rapid breathing;
- purple spots on the skin;
- confusion of consciousness;
- cold, clammy, or pale skin;
- the person is unresponsive or has lost consciousness;
- the eye protrudes, it hurts when moving the eyes, or swollen eyelids do not open;
- double vision appeared or vision worsened.
To the doctor on the same day, if:
On the same day: the bump is red, painful, hot or swollen; redness spreads around, in particular on the eyelid; pus flows from the cyst. Do not squeeze it - this way the infection can spread. Planned: the lump does not hurt and does not change - make an appointment for a consultation when it is convenient. Also show the doctor any bump, the nature of which you do not know, and if it grows quickly or has changed, do not delay.
05 / DIAGNOSTICSAs defined,
As defined,
what kind of lump is this
- Conversation
When the lump appeared, was it growing, was it inflamed; do relatives have cysts; whether it has already been disclosed or deleted.
- Review
The doctor evaluates the size, density, mobility, looks for a dark spot in the center; looks for inflammation.
- Ultrasound if necessary
Ultrasound shows how deep the formation lies and whether it looks like a cyst; so, for example, they recognize a tricholemal cyst.
- Histology
The removed tissue is examined under a microscope if the diagnosis is unclear, the formation is unusual or rapidly growing.
06 / TREATMENTHow we treat
How we treat
atheroma
If the cyst does not bother you, you can not touch it. The most reliable way to get rid of it is to remove it together with the membrane: while the membrane remains, the cyst can fill again. An inflamed cyst is first treated, and removed when the inflammation has passed.
01
While the cyst is calm
Treatment is not always necessary.
- You can observe
- If the cyst does not hurt, does not become inflamed and does not interfere, treatment is not necessary.
- Do not squeeze
- The cyst can burst and become infected, and if it is already infected, the infection will spread.
- When to delete
- If the cyst becomes inflamed, grows, interferes or is noticeable on the face, it is removed as planned.
02
Inflamed atheroma
What to do when the cyst is red and painful.
- Opening and drainage
- The doctor opens the cyst, releases the contents and, if necessary, takes a culture. In 76 light inflamed cysts, almost half of cultures (47%) did not reveal pathogenic bacteria.
- Antibiotics — as indicated
- They are prescribed by a doctor if there is an infection; with mild inflammation, they are not always needed.
- Deferred deletion
- An inflamed cyst is difficult to remove completely, so they often wait for the inflammation to pass and remove it on a planned basis.
- Delete immediately
- In some cases, the inflamed cyst is removed immediately: in a study, 166 patients who had the cyst removed immediately, compared with 185 after conventional treatment, took less time on antibiotics and had fewer complications.
03
Scheduled deletion
Under local anesthesia.
- Complete excision
- The cyst is cut out together with the shell. In a review of 5 studies (1,303 patients), cysts returned less often after complete excision than after opening.
- Puncture incision
- The cyst is emptied and the membrane is removed through a small round opening. In a study of 60 patients, the wound size was 0.73 cm versus 2.34 cm with conventional excision, and there was no difference in recurrence. The method is suitable for cysts of 1–2 cm on the face.
- Minimal cut
- For cysts up to 1 cm on the face, an incision of about 3 mm is possible; larger cysts could rarely be removed in this way.
- After surgery
- A small scar remains. Over time, new cysts may appear in other places.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
At the Dr. Valikhnovskyi Institute of Surgery, atheromas of the face, behind the ear, and earlobe are treated in the "New Face" direction. The incision is planned so that the scar is as little noticeable as possible, and after inflammation or previous interventions, the skin is also restored.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Removal of skin and soft tissue formations — the cyst is removed together with the membrane; if necessary, the removed is examined under a microscope.
- Local patches — if a defect remains after the removal of a large cyst, it is covered with tissues from the neighboring area — they are the closest in color and texture.
- Scar correction - coarse scars after inflammation, opening or previous removal are excised and closed with local tissues.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the lump directly and from the side - the doctor will first assess the situation.
- ConsultationExamination, if necessary, ultrasound; if the cyst is inflamed, first treat the inflammation.
- PlanThe method of removal and the location of the incision — taking into account the size of the cyst and where it lies.
- RemovalUnder local anesthesia, together with the shell.
- RecoveryThe doctor will explain how to care for the seam and when to come for an examination; if necessary, the result of histology.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Are atheroma and lipoma the same thing?
No. Atheroma is a cyst with a membrane filled with keratin. Lipoma is a benign tumor of soft tissues under the skin. They can be distinguished by examination and, if necessary, ultrasound.
Is it possible to squeeze out atheroma yourself?
No. The cyst can burst and become infected, and if it is already infected, the infection will spread. At the same time, the membrane remains, so the cyst can fill again.
Will the atheroma be absorbed by itself?
A cyst may not change for years, sometimes empty through an opening or become inflamed. As long as the shell is in place, it can be refilled.
Are antibiotics necessary if the atheroma is inflamed?
Not always. The inflammation is often caused by rupture of the membrane, not by bacteria: in almost half of cultures from inflamed lung cysts, pathogenic bacteria were not found. The doctor decides whether antibiotics are needed.
Will atheroma return after removal?
If the cyst is removed together with the membrane, it returns less often than after simple opening. But later, new cysts may appear in other places.
Will there be a scar?
A small scar remains. For cysts of 1–2 cm on the face, it is possible to remove them through a small round hole: the wound after it is shorter than after the usual excision.
Can atheroma turn into cancer?
This is a rarity: 56 cases of cancer in an epidermoid cyst have been described in the English-language literature. If the cyst is unusual or growing rapidly, it is examined under a microscope.
Why should a lump behind the ear be shown to the doctor?
There are various formations behind the ear. Among 52 patients with tumors behind the ear, 15 had epidermoid cysts and 6 had skin cancer.
Sources
16 sources · reviews, guidelines and researchshowCollapse
- Epidermal Inclusion CystStatPearls, 2026pubmed.ncbi.nlm.nih.gov/30335343 ↗
- Diagnosing Common Benign Skin TumorsAmerican Family Physician, 2024pubmed.ncbi.nlm.nih.gov/39418568 ↗
- Common benign skin tumorsAmerican Family Physician, 2003pubmed.ncbi.nlm.nih.gov/12613727 ↗
- Minimal excision technique for epidermoid (sebaceous) cystsAmerican Family Physician, 2002pubmed.ncbi.nlm.nih.gov/11996426 ↗
- Surgical Excision Versus Incision and Drainage for Epidermoid (Sebaceous) Cysts: A Systematic ReviewCureus, 2026doi:10.7759/cureus.102434 ↗
- Comparison of the surgical outcomes of punch incision and elliptical excision in treating epidermal inclusion cysts: a prospective, randomized studyDermatologic Surgery, 2006doi:10.1111/j.1524-4725.2006.32105.x ↗
- A new method for facial epidermoid cyst removal with minimal incisionJournal of the European Academy of Dermatology and Venereology, 2009doi:10.1111/j.1468-3083.2009.03191.x ↗
- A Retrospective Chart Review of Inflamed Epidermal Inclusion CystsJournal of Drugs in Dermatology, 2021doi:10.36849/JDD.5014 ↗
- One-stage excision of inflamed sebaceous cyst versus the conventional methodSouth African Journal of Surgery, 2010pubmed.ncbi.nlm.nih.gov/21542400 ↗
- Squamous cell carcinoma arising in an epidermal inclusion cystProceedings (Baylor University Medical Center), 2022doi:10.1080/08998280.2022.2077600 ↗
- Trichilemmal Cyst: Clinical and Sonographic FeaturesJournal of Ultrasound in Medicine, 2019doi:10.1002/jum.14666 ↗
- Clinical Characteristics of Idiopathic Epidermoid and Dermoid Cysts of the EarJournal of Audiology & Otology, 2017doi:10.7874/jao.2017.21.2.77 ↗
- Postauricular MassesJournal of Craniofacial Surgery, 2020doi:10.1097/SCS.0000000000006526 ↗
- Epidermoid Cyst of the Ear Lobule in AdultKathmandu University Medical Journal, 2021pubmed.ncbi.nlm.nih.gov/36259203 ↗
- Skin cystNHS, 2023nhs.uk/conditions/skin-cyst ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
The figures on the page are from these sources.
Bump on the face
or behind the ear?
Send a photo. The doctor will tell if it looks like an atheroma and how best to remove it.