Nodules are small lumps or bumps that form under the skin. They are usually benign (non-cancerous) but can sometimes be a sign of cancer. Nodules can form on any part of the body but are most commonly found on the neck, back, chest, arms and legs. The medical term for nodules is nodular lesions. Some common causes and types of nodules include:
- Lipomas – benign fatty tumors
- Cysts – fluid filled lumps
- Fibrous histiocytoma – benign tumor made up of fibrous tissues
- Neurofibromas – benign tumors that grow along nerves
- Ganglion cyst – benign fluid-filled lump that grows near joints and tendons
- Granuloma annulare – benign inflammatory skin condition
- Keloid – overgrowth of scar tissue
- Rheumatoid nodules – firm lumps caused by rheumatoid arthritis
- Skin cancer – melanoma or other cancers that start in the skin
Sometimes it is difficult to determine if a nodule is benign or malignant. A biopsy is usually needed to make an accurate diagnosis. If the nodule is found to be cancerous, surgical removal is typically recommended. But for benign nodules, non-surgical treatments may be effective in some cases.
Can Benign Nodules Be Removed Without Surgery?
Yes, there are several options for removing benign nodules without surgery:
Aspiration
This involves inserting a needle into the nodule and draining the fluid or removing cells for testing. Aspiration alone may cure cysts or reduce the size of other nodules.
Injection
Injecting a steroid medication directly into the nodule can reduce inflammation and shrink the lump. This works best on small inflammatory lesions like rheumatoid nodules. Several injections over time may be needed.
Freezing
Cryotherapy uses extreme cold to destroy abnormal cells. Liquid nitrogen is applied directly to the nodule with a cotton swab or spraying device. Freezing is effective at removing warts and some benign growths like fibromas.
Laser Therapy
Lasers provide high-energy light that can destroy nodules. Laser treatment works by heating up the lesion, which causes the cells to die. It may require several laser sessions to fully remove a nodule.
Radiofrequency Ablation
This treatment uses radio wave energy to heat up and destroy abnormal cells. A probe is inserted into the center of the nodule to deliver radiofrequency waves. This technique can successfully remove lipomas and similar benign growths.
Medications
Certain medications like steroid creams and injections can help shrink some types of nodules like keloid scars and rheumatoid nodules. The medicine helps reduce inflammation and lesions over time.
When is Surgery Necessary?
While the treatments above can effectively remove many benign nodules, surgery is sometimes still required in certain circumstances:
- If cancer is suspected – Surgical removal (excisional biopsy) is needed to both diagnose and treat malignant nodules.
- Very large nodules – Larger lesions may be difficult to treat with nonsurgical methods.
- Rapidly growing nodules – Quickly enlarging lumps should be examined and removed surgically if malignant.
- Nodules causing significant symptoms – Surgery may be considered if the nodule is painful, infected, bleeding or limiting mobility.
- Nodules that recur after other treatments – Persistent nodules that continue to return may need surgical excision.
- Cosmetic reasons – Some elect to have visible benign nodules removed surgically for cosmetic purposes.
So while nonsurgical treatments can be effective for some benign nodules, surgery may still be required or preferred in certain cases. Your doctor can help determine the best treatment approach based on the specifics of your nodule.
The Nodule Removal Procedure
If nodule removal surgery is recommended, the specific procedure will depend on factors like the location and size of the lesion. Here are some details on the surgical process:
Location
Nodules can be excised from any part of the body, but most commonly growths are removed from the:
- Head/neck – Often removed for cosmetic reasons or to biopsy lipomas, cysts and other lesions on the face, scalp or neck.
- Back – One of the most frequent sites for lipoma removal.
- Arms/legs – Common areas for removal of lipomas, neurofibromas, ganglion cysts.
- Chest/abdomen – Suspicious breast, skin or abdominal nodules may need surgical biopsy/excision.
Approach
There are a few possible approaches for nodule removal depending on location:
- Excision – Directly cutting out the entire nodule through an incision.
- Endoscopic – Using an endoscope inserted through a small incision to view and cut out the nodule.
- Laser – Using a laser inserted through an endoscope to destroy the lesion.
- Mohs – Progressive surgical removal and microscopic examination to ensure full eradication of growth.
The specific approach will depend on the nodule type, size, location and surgeon’s preference.
Anesthesia
Nodule removal surgery can be done under:
- Local anesthesia – Numbs only the area around the nodule.
- Conscious sedation – Uses IV medication for relaxation/pain relief while awake.
- General anesthesia – Puts you fully to sleep during the procedure.
Again, the choice of anesthesia depends on the surgery’s complexity and the patient’s needs.
Incision
The surgeon will make an incision near the nodule to access the lesion. This may involve:
- Elliptical excision – An oval shaped incision around the nodule.
- Punch excision – A round “punch” tool to cut out the lesion.
- Linear excision – A straight incision to remove the nodule.
The type of incision will vary based on factors like nodule location and size. The goal is to minimize scarring while completely removing the growth.
Closing the Incision
Once the nodule is excised, the incision will be closed using stitches, staples or medical glue such as Dermabond. For larger excisions, the wound may be left open to heal gradually over time. The surgeon will apply sterile dressings over the closure site.
Recovery
Recovery time after nodule removal surgery often includes:
- Bandages for 24-48 hours
- Stitches removal in 7-14 days
- Avoiding strenuous activity for 1-2 weeks
- Using pain medication as needed for discomfort
- Applying antibiotic ointment to the incision site
- Watching for signs of infection like redness/swelling
- Working to minimize scarring as the incision heals
Follow all your surgeon’s post-op wound care and activity instructions closely for proper healing.
Results of Nodule Removal Surgery
When performed appropriately, nodule removal surgery has good results:
- Benign nodules – Complete excision typically cures benign growths with very low recurrence rates.
- Malignant nodules – Removal of cancerous lesions can be curative, especially when caught early.
- Symptom relief – Eliminating the nodule usually resolves any associated pain, irritation, etc.
- Improved appearance – Patients are often pleased with the cosmetic results and minimal scarring.
- Accurate diagnosis – Excised tissue can be biopsied to confirm if abnormal cells are present.
Patients should notice the nodule resolve after healing from surgery. Follow up monitoring may be recommended to watch for potential recurrence. But overall, surgical removal is very effective at treating most benign nodules as well as diagnosing and eliminating malignant growths.
Risks and Complications
While generally safe, nodule removal surgery does carry some risks, such as:
- Bleeding
- Infection
- Poor wound healing
- Scarring
- Numbness
- Injury to surrounding tissue
- Recurrence of the nodule
- Reaction to anesthesia
Specific complications will vary based on the location and type of excision. Carefully following your surgeon’s instructions can help prevent complications and achieve optimal surgical results.
Cost of Nodule Removal Without Insurance
The typical cost of nodule removal surgery without insurance may range from:
| Nodule Removal Procedure | Cost |
|---|---|
| Small nodule excision with local anesthesia | $250 – $700 |
| Large nodule excision in operating room | $3,000 – $7,000 |
| Endoscopic nodule removal | $1,500 – $4,000 |
| Laser therapy to remove nodules | $500 – $1,500 per session |
| Mohs surgery for nodule removal | $1,000 – $3,000 |
Many factors affect the price including the surgeon fees, facility charges, anesthesia, number/size of nodules removed, and geographic location. Check if insurance covers all or part of the cost if having nodules removed medically rather than for cosmetic reasons.
Finding a Nodule Removal Surgeon
When looking for a doctor to remove a nodule, consider these tips:
- Check if your insurance plan covers the procedure and which surgeons are in-network.
- Look for a board certified dermatologist, plastic surgeon or general surgeon with experience removing nodules in your specific area of concern.
- Ask about the surgeon’s approach, expected results, potential complications and costs.
- View before and after photos of similar procedures the surgeon has performed.
- Read online reviews from previous patients.
- Schedule a consultation to meet the doctor and discuss your particular case.
Choosing an experienced, reputable nodule removal surgeon can help ensure you receive the best care and outcomes from the procedure.
Questions to Ask Before Nodule Removal
Important questions to ask your doctor before undergoing nodule removal include:
- What type of nodule do I have? Is it likely benign or malignant?
- What are my treatment options besides surgery?
- What surgical approach do you recommend for my nodule?
- Will the procedure require general anesthesia?
- How long will the surgery take?
- Where will you make the incision(s)?
- What kind of scar can I expect after surgery?
- What will my recovery and downtime be like after the procedure?
- What are the possible risks and complications?
- Will I need follow-up appointments or additional treatment?
- Do you expect the nodule to recur after removal?
- Will my insurance cover this procedure?
- What will be the total estimated cost if I pay out-of-pocket?
Getting all your questions answered allows you to make an informed decision about nodule removal surgery.
Conclusion
While many benign nodules can be successfully removed without surgery, surgical excision is still frequently required. The specifics of the procedure vary based on the nodule’s characteristics and location. When performed by an experienced surgeon, nodule removal surgery is typically an effective approach. However, risks and costs must be carefully considered as well. Having an open discussion with your doctor can help determine if nodule removal is the right choice for your particular case.