Should this patient be more concerned about her cyst?

CASE


An asymptomatic lesion had grown slowly on a 50-year-old woman's arm over the past 5 years. Eventually, the patient's husband insisted that she seek medical evaluation from her primary care provider who, in turn, referred her to dermatology. Further history-taking revealed that she had first noticed a tiny papule within a few weeks of having donated blood, which had necessitated a large-caliber needlestick at that site. She denied ever having had a similar lesion elsewhere on her body and claimed to be in generally good health. However, the patient had a history of a great deal of poorly tolerated sun exposure as a young woman.


Examination revealed a 3-cm, oval, shallow subcutaneous mass cov­ering most of the lateral aspect of her right antecubital area (Figure 1). The surface of the mass was smooth and rounded to a height of about 2 cm, with a highly symmetrical shape and well-defined borders. No overlying punctum was noted, and no change in color from the surrounding skin was seen. 


The lesion was uniformly soft and fluctuant on palpation, and it did not appear to interfere with flexion or extension. Results of a cursory neurologic examination of the patient's arm and hand were within normal limits, with no sign of muscle atrophy in either.