What are sclerotic lesions?

A sclerotic lesion is an unusual hardening or thickening of your bone. They can affect any bone and be either benign (harmless) or malignant (cancerous). In general, they’re slow-growing.

Both benign and malignant sclerotic lesions are usually classified by their number and size:

  • solitary: one lesion
  • multifocal: several distinct lesions
  • diffuse: several lesions without distinct borders in different locations

Benign sclerotic lesions are more common than cancerous ones and tend to be smaller as well.

Keep reading to learn more about the possible symptoms of sclerotic lesions and how they’re treated.

What are the symptoms?

Benign sclerotic lesions often don’t cause any symptoms. Many people don’t even know they have a sclerotic lesion until they have an X-ray or other imaging scan done for another condition.

However, malignant and larger benign sclerotic lesions may cause:

  • unexplained pain that gets worse over time
  • stiffness or swelling near the painful area
  • a lump in the painful area

The pain associated with sclerotic lesions often gets worse at night or after weight-bearing activities.

Your symptoms also depend on the size and location of the lesion. Malignant lesions on your spine can put pressure on nerves, causing a numbing or tingling sensation. Lesions in the neck might make it harder to swallow or breathe.

In addition, both benign and malignant sclerotic lesions can weaken your bone, making it more likely to fracture.

What causes them?

Many things can cause sclerotic lesions, from lifestyle factors to underlying medical conditions.

Causes of benign lesions

Possible causes of a benign sclerotic lesion include:

Ongoing bone infections, called osteomyelitis, can also cause benign sclerotic lesions. Osteomyelitis is often caused by:

Causes of malignant lesions

It’s rare for a malignant sclerotic lesion to start in your bone. Instead, they’re usually the result of cancer spreading from other areas. All types of cancer can metastasize and spread to your bones. However, the types of cancer that are most likely to spread to your bones include:

Other factors that might increase your risk of developing a malignant sclerotic lesion include:

  • high-dose radiation therapy
  • some medications used to treat cancer
  • hereditary bone defects
  • metal implants used to repair bone fractures

How are they diagnosed?

To diagnose a sclerotic lesion, your doctor will start by taking your personal and family medical history to identify or rule out any potential causes. Next, they’ll likely use a combination of imaging tests to get a better look at your bones.

These tests might include:

Depending on what the images show, your healthcare provider may follow up with a blood and urine test to help them narrow down any underlying condition that might be causing the lesion.

If you doctor suspects the lesion might be cancerous, they may also perform a bone biopsy. This involves using a needle-like instrument to remove a small sample of the lesion. They’ll look at this sample under a microscope to see if there’s any sign of cancer cells.

How are they treated?

Treating sclerotic lesions depends on whether the lesion is benign or malignant.

Treating benign lesions

Benign lesions are most often found in children and adults under 30. Some types of benign lesions don’t require treatment. Instead, your doctor might choose to just monitor it for any signs of change.

In other cases, you’ll need to work with your doctor to treat the underlying cause. Potential treatments include:

  • antibiotics for osteomyelitis
  • radiofrequency ablation, which uses heat to reduce pain
  • medications to reduce high blood pressure

Treating malignant lesions

Treating malignant sclerotic lesions also depends on the type of cancer and whether it originated in the bone.

For cancers originating in the bone, you may need a combination of chemotherapy and radiation, followed by surgery to remove remaining parts of the lesion.

Sclerotic lesions due to metastasized cancers usually require radiation treatment. In addition, your doctor might prescribe medications, such as bisphosphonates, to slow down destruction of the bone. In more severe cases, you may also need surgery to stabilize the affected bone.

What’s the outlook?

Sclerotic lesions have a broad range of possible causes and symptoms. However, they’re often harmless and don’t cause any symptoms or complications. When they are cancerous, they tend to respond well to a combination of surgery, radiation therapy, and chemotherapy.