Hard, Painful Scalp Lump: Seek Medical Evaluation

A hard, painful, fluid‑feeling lump on the occiput could represent:

• Epidermoid/pilar cyst: Often mobile, may become infected.
• Abscess: Fluctuant, erythematous, tender; needs incision/drainage.
• Hematoma: Post‑traumatic; firm then liquefies.
• Lipoma: Usually soft, non‑tender.
• Enlarged occipital lymph node: Reactive or malignant.
• Rare: Bone lesion, vascular malformation.

Immediate Steps

• Cold compress 20 min ×3–4/day.
• OTC analgesics (ibuprofen/acetaminophen).
• Avoid manipulation.
• See a clinician promptly for exam ± ultrasound ± biopsy. Do not attempt self‑drainage.