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Lumps, Skin Lesions, Though Scary, Shouldn't be Cause for Worry

By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital

You notice a lump on your child's neck. Was it there yesterday? Did your spouse notice it before now? Where did it come from? The average parent's mind begins to race and it isn't long before they're consulting Dr. Google.

The good news is that the lump is probably not a threat to your child's health, even if it takes a while to resolve. Kids' skin and soft tissue issues are common and usually result in worry, but are seldom dangerous.

There can be many causes for that new lump. If it surfaces out of the blue – not associated with an injury – and is painful, it's likely an infection. These are commonly caused by bacteria and bug bites. You'll need to have your child examined by a pediatrician, who will recommend treatment if it's needed.

What you've noticed could also be swollen lymph node – which sounds scary, but is usually a good thing. It means your child's immune system is working fighting an irritant or infection. You might notice these near the armpit, neck and groin or behind the ears. They'll usually be painless, small, multiple – about the size of a pea – and move slightly under your finger. Occasionally they rapidly increase in size and form an abscess inside the lymph node that may need antibiotics and drainage. The lumps that are the most concerning to your doctor are the ones that are hard, painless, and just keep growing and never get smaller particularly in the neck just above the collar bone of young teens. This can be the first presentation for cancer involving the lymph nodes called lymphoma but for every child we see with lymphoma or other malignancies we see a hundreds with swollen lymph nodes from inflammation or infection.

The first thing you should remember for skin lesions such as moles is that skin cancer is rare in children. While exposure to the sun over a lifetime makes adults more vulnerable to skin cancer, melanomas aren't common in children. Don't let an Internet search scare you into believing a new mole is cancer!

It's still important to be aware of any lesions on your child's skin, though, and monitor them for changes in shape, size and color – just as you would for yourself. Moles pop up on children, but they shouldn't be cause for alarm as long as they're smaller than a pencil eraser and have smoothly defined borders.

Everyone dreads warts, but they're also benign. These little annoyances are caused by a virus and show up without warning. Most go away after being treated with over-the-counter products like freezing or acid kits. Occasionally, one will be stubborn enough to require easy removal in a general practice or dermatologists' office.

We also see lots of children with rashes at Arkansas Children's Hospital. These cause parents a lot of grief because the child typically complains of itching and discomfort. Rashes are usually the result of an infection such as chicken pox or more commonly an irritant – anything from diapers to laundry detergent to poison ivy. Rashes from irritants will usually go away with topical treatments, like hydrocortisone cream or Caladryl lotion.

Of course, your child may also have had a birth mark that you've just noticed. Hemangiomas of infancy become noticeable after babies reach one or two months of age. You may have heard them referred to as "strawberry patches." They first become noticeable as a red streak or raised mark on any part of the body, but typically on the head, neck or trunk. The American Academy of Pediatrics estimates that two out of 100 infants have these birth marks.

Though the appearance of a hemangioma may bother Mom and Dad, they're usually painless and disappear on their own as the child ages, usually by the second or third birthday. It's important to point out any mark like this to your child's pediatrician so they can monitor its growth. In rare cases, a hemangioma may grow large enough to limit function if near the eye, throat or mouth. These can require treatment with medication or removal by a surgeon. But again, these are a minute portion of all hemangioma cases.

As with any health condition, it is important to keep an eye on lumps and skin lesions. If you notice pain, increased swelling, heat coming from the area or bleeding, you'll want to seek the opinion of your child's pediatrician.

Parents should rest assured that the vast majority of lumps and skin issues in kids aren't going to prevent a happy and healthy childhood. They may be scary, unsightly and annoying, but most will go away over time or with easy treatment.

Here's another tip: Be sure to download the new MyACH iPhone app, free from Arkansas Children's Hospital in the App Store. Everything a busy parent needs – from a health library to storage for your child's health info, insurance, medications and more.

Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email achconnect@archildrens.org.

Arkansas Children's Hospital
1 Children's Way
Little Rock, AR 72202-3591

Call: 501-364-1100

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