As a pediatric surgeon, a consultation for a lump on a child is one of the most common reasons for a referral to our office. Lumps can appear anywhere. They are commonly found when bathing the child or are noticed by a parent during everyday activities. Finding a new lump triggers anxiety in everyone involved, from the patient if old enough to understand, to the parents and family and even the primary care provider who evaluates the new lesion.
Almost every parent immediately worries that the lump is a “bad lump.” Parents want to know, is this cancer? Doing a Google search usually increases this anxiety. The good news is that most lumps are self-limiting, few need surgery and even when surgery is needed, less than five lumps biopsied (take a piece for diagnosis) per 1,000 return with a worrisome diagnosis.
Here are some steps you can take to gather more information at home and allow yourself to feel more at ease with what you found.
1. Gather information on each lump.
Get a notebook, and write down the following details on each lump. Be sure to keep this information in a safe place.
In children, lumps are most often located in the head and neck area. The location of the lump helps us narrow down the exact type of lump and what may be the best treatment.
Is the lump new? Is it in a location that you see often, and you know it has just appeared? Could it have been there for a while? Has the child or anyone else in the family noticed this before? If this has “popped up” quickly, chances are it may be due to a local infection. If it has been there for a long time, has it changed recently?
Does the lump extend below the skin and/or is the skin attached to it? Is the skin intact, or is there a break in the skin associated with the lump? Is the area raised, or is the lump completely below the skin surface?
How big is the lump? Very few of us are good at estimating its size, so get a pen, a ruler and your phone. Draw a circle around it, put the ruler next to it and measure. Take a picture with your phone to have an objective size and color of the lump that you can then compare to a picture the next day. Lumps that are worrisome are usually greater than 1 inch in size.
Is the lump the same color of the skin? Is it red or pale? If it is red, warm and tender, it is most likely caused by infection and will need to be seen by your primary care provider within a day or two. If the lump does not have characteristics of infection, usually waiting a few days is the best first step to see if the lump will grow or get smaller.
How is your child feeling? Are they tired, have a fever or had any other signs of being ill? Have they had a decreased appetite? Here is where you note anything that is out of the ordinary for your child in the past days or weeks.
2. What are next steps?
The next best step is to call your primary care provider with this information in hand. You will be able to relay all the information you gathered. This will help the office decide when the child needs to be seen. The good news is that most lumps, even ones due to infection, do not need to be seen in the ER or after hours. The final determination of evaluation is best left for your primary care provider. Therefore, the information gathered above is very important. It allows the best recommendations to be made.
I have an appointment. What can I expect?
Your primary care provider will ask you very similar questions and then compare the answers and the exam at the visit to when you first saw the lump. This second look is very important to the evaluation. Having this repeated assessment at the first visit – one by you and one by the provider – helps decide the best course of action. For example, if the lump measured 1 inch in diameter 3 days before and now is less than a half inch, then watchful waiting is the best choice.
For instances where the cause isn’t obvious, you may be sent for an ultrasound of the lump. This can give great information on the depth and characteristics of the mass. Many times, this is when your child will be referred to us in general pediatric surgery to decide if it needs to be biopsied (take a piece for diagnosis) or removed.
What are reasons to biopsy or remove the lump completely?
The lump is worrisome – If the size, location, history, exam or ultrasound characteristics of the lump warrant a procedure, the surgeon will explain the reasons, the timing and the procedure.
The child has worrisome symptoms – There are instances when the lump is not as concerning as the child’s symptoms since the lump was discovered. A biopsy of the lump would then help to identify the cause of the child’s symptoms.
If my child needs a surgeon, what can we expect?
The surgeon will ask very similar questions as your primary care provider. Again, getting more information on how the lump was found, where it is and how it is changing since it was first noticed. To simplify the reasons for surgery for a lump, the surgeon will assess the following: the lump itself, the child’s other symptoms and the parents’ input.
Most lumps that occur in children are benign. There are characteristics of the lump that will result in a surgeon recommending a biopsy. If you find a new lump on your child, stay calm and know that many lumps will go away with no intervention. Write down as much information about the lump as you can gather, and present the information to your primary care provider. Be your child’s advocate – and know that everyone wants to find the best, least-invasive way to care for your child.
Dr. Iocono is a pediatric general surgeon with Akron Children’s Hospital.