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InCYSTing on searching for explosives

DII small banner By Warren R. Heymann, MD
Sept. 8, 2016

I have enjoyed medical writing and editing since publishing my first article in 1983 when I wrote about a penile Fibroepithelioma of Pinkus (my medical school roommate’s father was the patient). Once in a great while, some interest would be generated from the dermatologic press (Dermatology News or Dermatology Times) about a particular topic. A first just occurred — I received an email from Reuters with questions about my article that was just published online in JAMA Dermatology (1).

My patient was a 72 year-old woman with an epidermoid cyst on her abdomen stopped by TSA agents after being scanned at an airport in Florida. She was unnerved by the experience of being examined by the agents who were concerned that she was concealing explosive devices. I asked her if she wanted the lesion excised — she declined. The brief article discusses the nature of scanning devices, a similar case of a patient being questioned because of his inguinal hernia, and I conclude with the following statement: “For as long as x-ray scanners are in use, it is essential that both screeners and passengers be knowledgeable about disorders that may be misconstrued as terroristic threats, thereby avoiding potential humiliation, embarrassment, and perhaps unnecessary surgery.”

Here is what Reuters wanted to know. My responses are italicized.

Please explain in simple terms how a full-body scan at an airport might mistakenly identify a cyst as a potential hidden explosive or security threat?

I cannot answer this question specifically. I can only assume that the TSA agent detected an abnormality on the scan that was reminiscent of a sac that could have contained contraband.

How common is it that cysts or tumors or other medical problems might be picked up and misidentified as security threats by airport scanners? Can you describe some specific examples — like does this happen to cancer patients or people with other types of medical conditions?

Again, I cannot answer this specifically and suggest that you speak with a TSA scanning expert. These machines are not MRIs that accurately image and diagnose skin lesions. They can detect abnormalities of contour that may warrant further attention by the TSA agent.

Until my patient told me her story, I had never encountered this situation. To the best of my knowledge, there has only been one similar case in the medical literature, as noted in my article — a man with a hernia. Theoretically it could also occur with other soft tissue tumors such as lipomas. I would surmise that other large skin lesions, including cancers could appear as an abnormal contour. Since I learned of this, I asked another patient who had multiple cysts on his trunk if he had ever been questioned at airport screenings. He told me that this has happened to him several times.

Big picture, what if anything can patients do to avoid the potential that their medical issues might be misidentified as security threats at the airport?

I would suggest that people be aware that this could happen to them if they have prominent lesions on their skin. Just knowing that should alleviate any anxiety. Having a letter from a physician noting the presence of a cyst, hernia, or other lesion might help, but understandably, the TSA agent may still wish to perform a pat down and a swipe for contraband. Mutual understanding and respect should allow the screening process to go smoothly.

I’m not sure how many news outlets will carry this story. I just wanted to give you the real scoop.
1. Heymann WR. A cyst misinterpreted on airport scan as security threat. JAMA Dermatology 2016; published online September 7th.

All content found on Dermatology World Insights and Inquiries, including: text, images, video, audio, or other formats, were created for informational purposes only. The content represents the opinions of the authors and should not be interpreted as the official AAD position on any topic addressed. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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