Carsten column: Skin lumps, bumps, and tags in dogs

A wide variety of skin lumps, bumps, and tags are encountered in dogs, especially as they age. They can arise from many different cells or structures in the skin like the oil glands and hair follicles. These skin changes range from mild concerns like simple skin tags to potentially serious health issues like cancer. Some lumps are more common in young dogs while other lumps are seen more frequently in older dogs. Fortunately benign (non-cancerous) lumps are more common than malignant (cancerous) lumps. When possible, determining the cause of the lump is important.

The location within the skin and placement on the body plays an important role in guiding decisions regarding steps for testing and diagnosis. For example, a lump on the skin surface of the neck that has a wart-like appearance in an older dog is likely a sebaceous adenoma while a wart-like lump on the lip of young dog is likely a viral papilloma (wart). This is important because they are treated differently and have different implications on how the pet companion is supported. Lumps or swellings that are red, warm, and painful show indications of inflammation and potential infection (abscess). It is important to note that some lumps that appear inflamed are not infected. These include sebaceous cysts and mast cell tumors.

Microscopic assessment of cells from the lump is important in most situations. This involves collection of cells in the lump using techniques like impression smears (discharges and tissue surface), collection in a needle (fine needle aspirate also known as FNA), and biopsy (lump removed and evaluated). These microscopic evaluations can be essential for determining what is causing the lump and, therefore, critical for identifying the best therapy.

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Treatment and prognosis are based on the diagnosis and how advanced the problem has become. Additional factors include the expected behavior of the lump, location on the body, and overall health of the pet. The expected behavior, for example, involves how aggressive a cancer may grow into the adjacent tissue and complicate removal and healing. It is important to note that behavior of some lumps is to be slow growing, not invasive locally or to spread to other parts of the body. Abscesses, on the other hand tend to progress from a firm, inflamed tissue to a fluid pocket that drains out through the skin.

Location can create concerns for the ability to adequately close the surgery site like when the lump is on the lower leg and there is limited extra skin for closure. Other lumps, like on the face, may be caused by an abscessed tooth that requires extraction and antibiotic therapy. Lumps on the eyelid are typically benign and can require special treatment considerations that maintains the shape of the eyelid.

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Overall health can influence the choice of surgery versus more conservative therapies. However, it is important to recognize that even an older pet with health issues can be safely anesthetized and undergo surgery or other procedures that require anesthesia.

Benign lumps can arise from any structure in the skin and include sebaceous adenomas, papillomas, basal cell tumors, sebaceous cysts, abscesses, histiocytomas, skin tags, cornifying epitheliomas, hair follicle tumors, and apocrine gland cysts. Malignant lumps can also arise from a range of structures in the skin and include mast cell tumors, squamous cell carcinomas, and melanomas. Note that each of these names provides important information about these lumps.

Prognosis and therapy for each of these conditions depends on the diagnosis and may include approaches like surgery, cyrosurgery, abscess drainage, antibiotics, steroids, chemotherapy, or radiation. Integrative supportive therapies may include approaches like topical essential oils that have anti-inflammatory or anti-cancer effects (i.e. frankincense), oral herbs that have anti-inflammatory and anti-cancer properties (i.e. boswellia, astragalus), and immune supportive nutrients (i.e. vitamins A, C,

D), mushrooms (i.e. turkey tail, reishi), herbs (i.e. echinacea, ashwagandha), probiotics, and glandular extracts.

Each skin lump, bump, and tag should be evaluated by your veterinarian and choices made about diagnostic procedures, therapy, and supportive care.

If you have questions about any skin lumps, or even lumps that are under the skin, contact your veterinarian.

Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs. Dr. Carsten is the 2022 Colorado Veterinary Medical Association Distinguished Service Award recipient.