Superficial lumps in children: what, when, and why?

Deciding whether a visible or palpable lump should be excised in a trivial problem if one believes that every unexplained mass in an infant or a child must be promptly removed. But with the present increased public awareness of cancer, this approach would unnecessarily raise parental anxiety. This review of superficial lumps excised in infants and children shows that approximately 1% are malignant. Although a precise diagnosis on the basis of clinical findings remains imperfect, four fifths of the malignant lesions can be recognized on the basis of five risk factors: onset in the neonatal period, a history of rapid or progressive growth, skin ulceration, fixation to or location deep to the fascia, and a firm mass greater than 3 cm in diameter. In the absence of any of these risk factors, parents can be reassured with a 99.7% accuracy about the benign nature of their child's lump at the initial consultation. Approximately 6% of these lumps will spontaneously regress and, therefore, do not require excision. However, more than 90% of superficial lumps will persist or slowly enlarge and should be electively excised for cosmetic reasons, to prevent late infection or inflammation, and to diagnose the remaining three malignant lesions per thousand lumps that would not be recognized using the above five risk factors.