Lumps : Examine the regional lymph nodes as well as the lump. If the lump is a node examine its area of drainage.
History : How long has it been there? Does it hurt? Any other lumps? Ever abroad? Otherwise well? Is it getting bigger?
Physical examination : Remember the six esses:- Site,shape,smoothness,surface and surroundings. Other questions:- Does it trans illuminate? Is it fixed to skin or underlying structures? is it fluctuant?
Lumps in certain sites call to mind particular pathologies. Remember to feel if a lump is pulsatile; this may seem to be a minor detail until you are faced with a surprise on a minor operations list.
Lipomas : These are benign adipose tissue tumours. They grow slowly and only cause symptoms through pressure. They have smooth imprecise margins and are fluctuant.
Sebaceous cysts : These lumps are in the skin itself, therefore it is impossible to draw the skin over the lump. Usually there is a characteristic punctum, which marks the blocked outflow from the sebaceous gland.
Lymph node enlargement may accompany any infective or neoplastic disease. Often no cause is apparent.
Rheumatoid nodules are collagenous granulomas which appear on the extensor aspects of joints-especially the elbows. They occur in established cases of rheumatoid arthritis.
Ganglia : These are fluid-filled synovial cysts which communicate with a tendon sheath or joint space. They transilluminate brilliantly. Some disappear or pressure.
Fibromas may occur anywhere in the body, but most commonly they are under the skin. These whitish benign tumours contain collagen,fibroblasts and fibrocytes.
Dermoid Cysts contain dermal structure. They are often found in the midline.
Malignant tumours of connective tissue include the fibrosarcoma, liposarcoma, leiomyosarcoma (smooth muscle malignancy), and the rhabdomyosarcoma which is a malignancy of striated muscle.
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