Ask Dr Gary: Painless lumps: do not ignore

Don't ignore painless lumps

Six months ago, I noticed a hard little lump on the palm of my right hand, just under the skin. Now I've got another one on the other hand. I practise martial arts, and work on a computer. I'm 45 and healthy. The bumps don't hurt. Should I be concerned? - D.H.

The commonest cause of lumps on the hands are calluses and warts. But these are clearly on the surface of the skin, not beneath it Foreign bodies - such as glass - can form granulomas, or little lumps of scar tissue.

I had a friend in his 70s who loved to show people the lump on his palm he had from shooting himself with an airgun when he was a child. He proved that the body is capable of scarring over a wide variety of materials and walling them off.

Below the skin is a latticework of connective tissue that holds the skin of the hand firmly in place. This can become scarred through heavy manual labour or trauma. For someone who uses their hands a lot, I'd wonder if there isn't scarring in the tissues from repeated trauma. One thing that doesn't fit is that the scarring should be much worse on your dominant hand.

Perhaps most relevantly, there's Dupuytren's contracture. This is a scarring disease that affects the connective tissues.

It starts as a tender nodule which extends to form a cord, or tether-like band, that can contract down, eventually causing the ring and small fingers to bend towards the palm. But with most people the disease is only very slowly progressive and non-disabling. For some, physiotherapy is all that's needed. In more severe variants, there are treatment options ranging from x-ray therapy to delay progression, to surgical removal of diseased skin and connective tissue, and skin grafting. Each carries varying risks of damage to surrounding nerves, infection, and the risk of recurrence.

See your doctor to get properly diagnosed, and discuss treatment.