GuidelinesOther guideline
An Approach to a Soft Tissue Mass
Doctor, I have a lump!
Introduction
Differential Diagnosis
Context: Outpatients
Introduction
Surgery OPD is full of patients who present with lumps. No matter where the lump is, there are six questions you need to explore when taking a history:
Question | Context |
Where is it? | The clinical implications and differential diagnosis are very different depending on where it is! |
When and how did you first notice the lump? | Was it noticed incidentally, whilst looking in the mirror, or did the patient’s partner point it out? When was it first noticed? |
How has the lump changed since you first noticed it? | Has it got bigger, smaller, stayed the same size or has it come and gone? Has it changed its appearance and consistency? |
What symptoms does it cause you? | Is it painful? Does it cause any other symptoms? Symptoms usually are related to the anatomical site |
Have you got any more/had it before? | If the patient has many lumps, are they the same? If the patient has had this before, what happened to it the last time, and what did the doctor say it was? |
What do you think it is? | Most patients worry that this could be cancer. You have to be aware of the patient’s concerns if you want to be able to reassure them |
Differential Diagnosis
Location | Common | Don't want to miss |
Neck | Lymphadenopathy Sebaceous cyst | Thyroid and ENT cancer, lymphoma |
Axilla | Lymphadenopathy Abscess | Breast cancer |
Breast | Breast cancer Fibroadenoma Abscess | Breast cancer |
Groin | Hernias Lymphadenopathy Abscess | Incarcerated hernia Aneurysms |
Perianal region | Abscess Prolapsed haemorrhoids | Rectal cancer Necrotising sepsis of the perineum |
Thigh/buttock | Lipoma | Sarcoma |
Each of these anatomical sites will be explored further.