Hi, The most common problem leading to a hard knot over the back of the wrist is either a carpal boss, which is a hard swelling which forms at the junction of the wrist and hand bones. It is mainly related to common wear and tear processes occuring in the joint and very occasionally leads to any problems. Another possibility is a ganglion, which is an outpouching of extra lubricant fluid around the tendons crossing the wrist that can appear like this.It can be a cause of carpal tunnel, which is when it would be requiring surgery. But only if you have symptoms of carpal tunnel syndrome such as tingling and pins and needles over the palm of your hand, wasting of t he muscles over the palm, weak finger grip is when it could be a likely cause for which you would need to seek treatment but otherwise it is again not a reason to worry as that is not a common occurence. So my suggestion would be to leave it unless it is causing pain or loss of function. Cosmetic problem alone is not enough to warrant removal. Thank you.