Lumps can appear anywhere. They are commonly found when bathing a 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.
As a pediatric surgeon, I am often asked for a consultation for a lump on a child referred to our office. 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, fewer than five lumps biopsied per 1,000 return with a worrisome diagnosis. Here are some steps you can do to gather more information at home and feel a bit more at ease with this new finding with your child.
Location
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.
Depth
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?
Timing
Is the lump new? Is it in a location that you see often, and you know 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?
Size
How big is the lump? Very few of us are good at estimating 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.
Color
Is the lump the same color as 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.
Symptoms
How is your child feeling? Are they tired, do they have a fever or are they showing any other “parent radar” 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.
What should I do next? When do I call my primary care provider? Do I need to go to the ER?
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 to 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 will happen there?
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 it. This second look is very important to the evaluation. Having this repeated assessment at the first visit (one by you and one by the primary care provider) helps decide the best course of action. For example, if the lump measured 1 inch in diameter three 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 a specialist to decide if it needs to be biopsied (a piece taken for diagnosis) or removed.
Reasons to biopsy (take a piece) or remove 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 I need to see a surgeon, what can I expect there?
The surgeon will ask very similar questions as your primary care provider. Again, to get 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 go away with no intervention.
Write down as much information as you can gather about the lump 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. Joseph A. Iocono, pediatric general and thoracic surgery at Akron Children’s Hospital. It’s part of the Division of General Pediatric Surgery at Akron Children’s Hospital. The group of surgical specialists include: Dr. Robert Parry; Dr. Scott Boulanger; Dr. Todd Ponsky; Dr. Nathan Heinzerling; Dr. Justin Huntington; Dr. Douglas Potoka; and Dr. Mark Wulkan. 330-543-6060. akronchildrens.org
If you have any medical concerns about your child, please contact your pediatrician or other medical professionals for advice. Seek immediate assistance if your child is having an emergency by calling 911.
