Chapter 116: Common lumps and bumps

INTRODUCTION

Lumps and bumps are very common presentations and the skin a very common site for neoplastic lesions. Most of these lesions only invade locally, with some important exceptions, notably malignant melanoma.

Pigmented skin tumours thus demand very careful consideration, although only a very few are neoplastic. The optimum time to deal with the problem and cure any skin cancer is at its first presentation. The family doctor thus has an important responsibility to screen these tumours and is faced with two basic decisions: the diagnosis and whether to treat or refer.

Most skin lumps are benign and can be left in situ, but the family doctor should be able to remove most of these lumps if appropriate and submit them for histological verification. The main treatment options available in family practice are: biopsy, cryotherapy, curette and cautery, excision or intralesional injections of corticosteroid.¹ A list of common and important lumps is presented in TABLE 116.1.

A DIAGNOSTIC APPROACH TO THE LUMP

As with any examination, the routine of look, feel, move, measure, auscultate and transilluminate should be followed.

The lump or lumps can be described thus:

• number

• site

• shape—regular or irregular

• size (in metric units)

• position

• consistency (very soft, soft, firm, rubbery or hard)

• solid or cystic

• mobility

• surface or contour

• special features:

  • – attachments (superficial/deep)

  • – exact anatomical site

  • – relation to anatomical structures

  • – relation to overlying skin

  • – colour

  • – temperature (of skin over lump)

  • – tenderness

  • – pulsation (transmitted or direct)

  • – impulse

  • – reducibility

  • – percussion

  • – fluctuation (?contains fluid)

  • – bruit

  • – transilluminability

  • – special signs: slipping sign, emptying sign of cavernous haemangioma

  • – spread: local, lymphatic, haematogenous

  • – regional lymph nodes

  • – ?malignancy (is it primary or secondary?)

Relation of the lump to anatomical structures²

The question ‘In what tissue layer is the lump situated?’ needs to be addressed.

• Is it in the skin? The lump moves when the skin is moved (e.g. epidermoid cyst).

• Is it in subcutaneous tissue? The skin can be moved over the lump. The slipping sign: ...