Painful Back Lumps: When to Seek Medical Attention - Dermatology

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When it comes to painful lumps on the back, especially in an elderly patient like your father, it is crucial to approach the situation with caution and thoroughness. Given that your father is 74 years old and has a history of a lump diagnosed as a sebaceous cyst (commonly referred to as a "pilar cyst" or "wen"), the recent changes in the lump's characteristics—such as increased size and pain—are concerning and warrant further investigation.

Sebaceous cysts are generally benign and can be asymptomatic for long periods. However, when they become painful, grow larger, or show signs of infection (such as redness, warmth, or drainage), it is essential to consider other potential diagnoses. The fact that your father has experienced a recurrence after treatment at a traditional Chinese medicine clinic, where the cyst was manually expressed, suggests that the cyst may not have been completely removed or that there could be another underlying issue.

There are several possibilities for the painful lump on your father's back:
1. Infection: If the cyst has become infected, it may present with increased pain, swelling, and possibly fever. An infected cyst may require antibiotics and possibly drainage.

2. Lipoma: This is a benign tumor made of fat tissue that can also present as a lump under the skin. While generally painless, they can become uncomfortable if they press on surrounding structures.

3. Malignant Tumors: Although less common, any new or changing lump in an older adult should be evaluated for the possibility of skin cancer or other malignancies. This is especially true if the lump has changed in size, shape, or color.

4. Other Skin Conditions: Conditions such as dermatofibromas, keloids, or even other types of cysts could also be responsible for the lump and associated pain.

Given these considerations, it is advisable for your father to seek evaluation from a qualified healthcare provider, preferably at a larger medical facility where comprehensive diagnostic tools are available. A dermatologist or a general surgeon would be appropriate specialists to consult. They may recommend imaging studies, such as an ultrasound or MRI, to better understand the nature of the lump and to rule out any serious conditions.

In summary, the increasing size and pain associated with your father's back lump, especially after a previous diagnosis of a sebaceous cyst, necessitate a thorough reevaluation. It is prudent to seek care at a larger hospital where he can receive a comprehensive assessment, including potential imaging and possibly a biopsy if warranted. Early intervention can help prevent complications and ensure appropriate treatment, whether that involves surgical removal, medication, or further monitoring.