Sasha the 12 year old cross-bred terrier

Sasha is a good example of how successful a rescued dog can be: there is no need to buy an expensive pedigree or designer breed puppy. Phil took her on from a rescue centre when she was a young adult dog, and she has been a wonderful pet.
A year ago, Sasha needed to have a 1cm diameter skin tumour removed from her right back leg. A simple biopsy had suggested that it could be something sinister, and so an operation was recommended. After the tumour had been surgically excised, it had been submitted to the laboratory for histopathology. This is the only way to  make a definitive diagnosis of the precise type of any tumour. In the end, it was good news: the tumour was a trichoepithelioma, also known as a follicular cyst. This is a benign skin tumour that is cured by surgical excision with a wide margin, which is what we had done.
We had hoped that this would be the end of Sasha’s troubles, but just three months later, two more skin lumps appeared, in a different location. This time they were on the left hand side of her lower back. The question was: would she need to have these removed as well? It had taken her a while to get over the operation to have just one lump removed. It would be a much bigger procedure to remove these two.
Again, we took the simple initial step of taking a rapid biopsy, known as a Fine Needle Aspirate (FNA). I pushed a sharp, fine, needle into each lump. I then used a syringe to suck back, collecting a sample of the cells inside each lump. This time, there was not even any need to send the samples off to the laboratory for analysis: the syringe drew back thick, pasty material known as sebaceous secretions. This confirmed that the two lumps were definitely not anything sinister or malignant. They were cysts, and given her previous history, it was most likely they were the same as last time: follicular cysts, a benign type of tumour derived from glandular structures in the skin itself.
The first time, this definitive diagnosis was only able to be made after surgical removal; this time, the simple sample was sufficient.
Now that we knew what they were, Phil had to decide what approach to take to dealing with them.
As before, it would be possible to surgically excise the lumps, and this would provide a full, long term cure. However it would be a major operation which Phil would prefer to avoid if possible.
The second option was to take a conservative approach, which would mean not taking any drastic action like surgery. This would involve simply monitoring the lumps, keeping an eye out for any change in their appearance or size. We already knew that the lumps were not malignant, so they weren’t going to spread to anywhere else in her body if we left them.
There were two possible complications with leaving them in situ: first, sometimes this type of cyst grows bigger, and then ruptures, oozing discharges. And second, sometimes they become infected, which means that they become red, sore and swollen.
However, it was possible that neither of these eventualities would ever happen: the lumps could stay as they were for several years to come. And Sasha was already an older dog, at twelve years of age.
After we discussed the various options, Phil decided to leave the lumps in place, just keeping a careful eye on them.
All was well for ten months. The lumps stayed around the same size, and they didn’t bother Sasha at all. Then, just two weeks ago, Sasha started to lick the skin around the lumps. She had never done this before, but now it was as if she couldn’t stop. The skin in the area turned red, and looked itchy. Something had clearly changed, so Phil brought her to see me.

the cysts had become infected

When I examined Sasha, I could tell at once that the two lumps had increased in size, and the skin around them was swollen and inflamed. She had developed one of the complications that does happen from time to time: one of the cysts had become infected. Her body was now reacting to this infection, which is why the skin in that area was red, sore-looking and itchy.
The good news was that simple treatment would rapidly help her.
First, I used a needle to drain out a syringeful of infected liquid from the cyst that had swelled up. Second, I put her onto some potent antibiotic tablets: these should quickly eradicate the infection. Third, I prescribed some anti-inflammatory cream to rub into the red, sore skin around the cysts: this should at least ease the itchiness.
And finally, Sasha has to wear a lampshade-type collar for the next week or so. When a dog licks and chews at itchy skin, they end up making it far worse. The collar will force Sasha to leave herself alone, and after just a day or so of treatment, the itchy sensation will have gone and she’ll feel much better.
After ten days or so of treatment, the cysts should have calmed down, returning to the passive way they were prior to the infection. And hopefully it will be many more months before another infection. And with luck, it might not ever happen again.