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Condition

Benign Hand Masses

Most lumps and bumps on the hand are not cancer. Here are the ones we see most often, how to tell them apart, and when to remove them.

Overview

Noticing a new lump on the hand can be worrying, but the great majority of hand masses are benign. The most common by far is a ganglion cyst, which has its own page. Another very common bump related to arthritis is the mucous cyst. This page covers the next-most-common hand masses that are not those two: lipomas, giant cell tumors of the tendon sheath, epidermal inclusion cysts, and glomus tumors.

Cancerous (malignant) tumors of the hand are rare, but they do exist. A mass that is growing, firm, fixed, painful, or changing the skin over it deserves to be evaluated rather than ignored. When a mass has any worrisome features, an MRI and sometimes a biopsy are part of the work-up.

Lipoma

A lipoma is a benign tumor made of mature fat cells. On the hand it is usually a soft, rubbery, slow-growing lump under the skin of the palm or the back of the hand. Small lipomas are painless and can be left alone. Larger lipomas, particularly in the palm, can press on nearby nerves and cause symptoms that look like carpal tunnel or cubital tunnel syndrome. Removal is through a small incision over the mass and is an outpatient procedure.

Giant cell tumor of the tendon sheath (GCTTS)

Despite the alarming name, a giant cell tumor of the tendon sheath is benign. It is the second most common hand tumor after the ganglion cyst. It typically appears as a firm, non-tender nodule on the palm side of a finger, arising from the sheath around the flexor tendon. It grows slowly and can extend around the tendon, sometimes into the joint or even eroding the bone. Diagnosis is made by exam, x-ray, and often MRI. Treatment is surgical excision. Recurrence is possible (reported at around 10–30%) because small satellite nodules can be left behind; complete removal and careful follow-up reduce that risk.

Epidermal inclusion cyst

An epidermal inclusion cyst forms when skin cells get buried under the surface, often after a small puncture wound, and then slowly grow into a fluid- and keratin-filled cyst. On the hand these are most common in the fingertip or palm. They feel firm and are attached to the skin rather than floating underneath it. They are removed when they become painful or large enough to interfere with function. The whole cyst wall needs to be excised; otherwise it will recur.

Glomus tumor

A glomus tumor is a small, benign tumor of the tiny blood-vessel structures that help regulate temperature in the fingertips. It is rare, but has a very characteristic set of symptoms worth recognizing:

  • Severe, out-of-proportion, pinpoint pain in the fingertip
  • Exquisite sensitivity to cold (dipping the hand in cold water reproduces the pain instantly)
  • A tiny blue or purple spot visible through the nail, sometimes with a ridge in the nail

These tumors often go undiagnosed for years because they are small and because patients are told the pain is "just a sensitive finger." An MRI of the fingertip can confirm the diagnosis. Surgical removal is curative and provides dramatic relief, usually the same day.

How benign hand masses are diagnosed

  • Exam. Location, firmness, mobility, tenderness, and skin changes all give strong clues.
  • Transillumination. Shining a small light through the mass — a classic way to tell a fluid-filled cyst (like a ganglion) from a solid mass.
  • X-rays. Useful if there is concern about bony involvement or if the mass is firm.
  • Ultrasound or MRI. Ordered when the diagnosis is uncertain, when the mass is deep, or when a glomus tumor or GCTTS is suspected.
  • Biopsy. Reserved for masses with any features suspicious for malignancy.

Treatment options

Treatment depends on the specific mass and the symptoms. Small, painless, stable masses can often be watched. Masses that are painful, growing, pressing on a nerve, or concerning on imaging are removed. Almost all of these are outpatient procedures performed under local or regional anesthesia.

What to expect at your visit

Dr. Barrera will examine the mass, discuss the likely diagnosis, and order imaging selectively when it will change the plan. For clearly benign, asymptomatic masses, observation is a reasonable choice. For painful or worrisome masses, an excisional biopsy serves as both diagnosis and treatment.

Dr. Barrera's approach

Not every hand lump needs to come out. The goal of the first visit is to identify which ones are harmless and can be watched, which ones are uncomfortable enough to warrant removal, and which ones have features that demand imaging or biopsy. Glomus tumors deserve a specific mention — they are rare, but when a patient has the classic triad of pinpoint pain, cold sensitivity, and a blue spot under the nail, treatment is extremely satisfying because it resolves years of pain in a short operation.

When to call the office sooner

Call us if a hand mass is growing quickly, is rock-hard or fixed to the deeper tissue, is painful without a clear reason, is changing the skin over it, or is associated with new numbness or weakness in the hand.

Related

Ganglion cyst · Mucous cyst

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