Lump Above the Temple: Causes, Evaluation, and When to Worry

Differential Diagnosis for a Temporal Lump

Common Benign Causes

• Swollen lymph node: Reactive to scalp/face/ear infection (viral, bacterial, fungal).
• Sebaceous cyst: Blocked sebaceous gland; mobile, may have punctum.
• Lipoma: Soft, mobile, doughy fatty tumor.
• Pilar (trichilemmal) cyst: Firm, scalp-based, from hair follicle.
• Dermatofibroma: Firm, dimples on pinch.

Inflammatory/Infectious

• Abscess/furuncle: Tender, fluctuant, erythematous.
• Insect bite/sting: Local reaction, often pruritic.
• Herpes zoster (shingles): Dermatomal vesicles, pain precedes rash.

Bone/Deep Origin

• Osteoma: Hard, fixed, slow-growing benign bone tumor.
• Fibrous dysplasia: Bone replaced by fibrous tissue.

Concerning Features (Red Flags)

• Rapid growth, fixation to deeper tissue.
• Skin changes (ulceration, discoloration).
• Neurologic symptoms (facial numbness, weakness).
• Systemic: weight loss, night sweats, fever.
• History of cancer.

Evaluation

1. History & exam (consistency, mobility, tenderness, transillumination).
2. Ultrasound (first-line for soft tissue).
3. CT/MRI if bone involvement or deep extent suspected.
4. Biopsy (FNA or excisional) if malignant features.