Skin Tumors in Infants: When to Seek Surgery?

Six-month skin tumor?

I would like to ask the doctor, my baby is six months old, and recently in the past three weeks, we have noticed a hard lump at the elbow, which is firm and well-defined.
An ultrasound performed by a pediatrician indicated no blood flow.
After a physical examination by a surgeon, it was suggested that it could possibly be a sebaceous cyst, which is 90% benign.
However, a biopsy is necessary to confirm this.
Due to a certain doctor's impatience, we were hesitant to ask more questions.
Our concerns are: 1.
Given that the lump is well-defined, firm, has no blood flow, and does not seem to cause pain, can we continue to monitor it for any changes in size, or is immediate surgery recommended? 2.
Can the baby undergo surgery with local anesthesia? It's okay if the baby cries, as they are still very young and their organs are not fully developed.
3.
If we opt not to have surgery and instead perform a biopsy, is that appropriate? What potential complications could arise from that?

Niming, 0~9 year old female. Ask Date: 2019/10/09

Dr. Xu Kaixi reply Surgery

1.
If the current examination suggests a benign tumor, observation and follow-up can be considered unless the tumor is large (greater than 1-2 cm), in which case surgical removal may be warranted if there are significant changes.

2.
For a six-month-old child, excising a subcutaneous tumor can be considered safer with local anesthesia.

3.
Based on your description, the likelihood of the tumor being benign is high, and a biopsy may not be necessary.

Reply Date: 2019/10/09

More Info

When it comes to skin tumors in infants, particularly in your case with a six-month-old baby who has developed a hard lump on the elbow, it is essential to approach the situation with caution and informed decision-making. Based on the information provided, the lump appears to be well-defined, firm, and without blood flow, which are generally positive indicators suggesting a benign condition, such as an epidermoid cyst (commonly referred to as a sebaceous cyst).
1. Observation vs. Immediate Surgery: Given that the ultrasound shows no blood flow and the lump is not causing any pain or discomfort, it may be reasonable to consider a period of observation. If the lump remains stable in size and does not exhibit any concerning changes (such as rapid growth, redness, or tenderness), monitoring it over time could be a viable option. However, if there are any changes or if the lump grows larger than 1-2 cm, surgical intervention may be warranted. The decision to operate should always be made in consultation with a pediatric surgeon who can evaluate the lump's characteristics and the child's overall health.

2. Use of Local Anesthesia: For a six-month-old infant, the use of local anesthesia can be considered for minor procedures, especially if the lump is small and accessible. However, it is crucial to understand that infants may not cooperate during the procedure, which can complicate the use of local anesthesia. In many cases, general anesthesia is preferred for young children to ensure they remain still and comfortable throughout the surgery. The risks associated with general anesthesia are generally low, especially in healthy infants, but should be discussed thoroughly with the anesthesiologist and surgeon.

3. Biopsy Considerations: If surgery is not performed immediately, and a biopsy is considered, it is important to note that obtaining a biopsy from a small lump in an infant can be challenging. A biopsy may involve a small incision, which could lead to scarring or other complications. While the risk of significant complications is low, any surgical procedure carries some degree of risk, including infection, bleeding, and scarring. If the lump is indeed benign, the need for a biopsy may be less critical, especially if the clinical presentation is reassuring.

In summary, the decision regarding surgery or observation should be made collaboratively with your healthcare team, considering the characteristics of the lump, the infant's overall health, and the potential risks and benefits of each approach. Regular follow-up appointments can help monitor the situation and ensure that any changes are addressed promptly. Always feel free to ask your healthcare provider any questions you may have; they are there to help you understand your child's condition and the best course of action.

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