• Most present @ swellings or ulcers (aka "lumps and bumps" and "sores" respectively)
• Lump = swelling
• Bump - haematoma (from olden times)
• Methodical P/E adequate to Dx + Tx (sophisticated Ix not needed)

• Introduce yourself to Pt
• Gain consent
• Expose adequately (mention ideal exposure to examiner)
• Ask if lump painful

1. Tenderness: if present, P/E not as thorough ("on palpation is tender, therefore cannot perform exam properly"; 1-3 on superficial palpation); may be due to inflammation, infiltration
2. Temperature: if relevant (large size, inflammation)
3. Reconfirm the size: may be larger on palpation cf. inspection
4. Consistency (soft, firm, hard - due to tissue or pathology?): usu. require deep palpation (soft = cheek eg. Lipoma; firm = tip of nose eg. Inflam, tumour in capsule; hard = skull eg. Bone, LN/ tumour infiltration); variations: soft-to-firm; firm-to-hard; variable consistency
5. Attachment to superficial and deeper structures (nature and pathology): originate from that organ (eg. Sebaceous cyst), inflammation, tumour infiltration (eg. Ca br: no attachment to skin, ask Pt to contract m, find it attached to pec m); superficial = move; deep = contract muscle
6. Mobility: neurofibroma mobile in one direction but not other
7. Fluctuation: semi-solid liquid, pressing on one side displaces other side; not reliable in lumps <1 cm diameter (cannot fix, may be feeling subcut fat); if thick capsule and fluid under tension, no fluctuation; lipomas are fluctuant but not nec transilluminate
8. Transillumination: not reliable in lumps < 1 cm diameter (light transmission appears like transillumination)
9. Regional LN: if suspect infection or malignancy; eg. Foot ulcer - examine popliteal, hand - examine axillary, lipoma (not infection) therefore no need to examine LN

Usually not required

Usually for vascular lesions

SLIDE: angioedema?

SLIDE: pigmented lesion

• Preauricular lesion of L ear
• Oval in shape, size 4cm x 2cm
• Surface pigmented, irregular
• Pigmented lesion: basal cell carcinoma, melanoma
• Surface: cauliflower papillary surface
• Surrounding skin bloodied (biopsy taken)
• Attachment: arises from skin
• Even if don't know Dx -> pigmented papilloma (clinical Dx)

SLIDE: (non-pigmented) papilloma

• Viral in origin
• Arising from skin
• Surrounding skin normal
• Must examine LN

SLIDE: bluish discoloration behind lobe (sebaceous cyst)

• Also has keloid on front of lobe

SLIDE: previous burns

• Hypertrophic scars
• Keloids
• Diffuse (not localised)
• Pinkish discoloration

SLIDE

• Papillary, origin from skin (upper eyelid)
• Pedunculated
• Soft-firm (some fibrous tissue)

SLIDE

• Nevi (nevus) - moles near clavicle
• Papillary surface (cauliflower)
• Examine LN (cervical, axillary)

SLIDE

• Consistency of lipoma, not papillary
• Lipoma = subcutaneous
• Intradermal lipoma: break through skin
• No pedicle (sessile: attached by a broad base, as opposed to being pedunculated or stalked)

SLIDE

• Lumps on forehead - one soft (lipoma), one hard ((osteoma)
• Osteoma: very rare, lump in middle of forehead, not malignant

SLIDE

• Appears inflammatory
• On palpation, not bacterial, due to stretching of skin

SLIDE

• O/I: obvious swelling
• P/E: multiple LN
• Some things not obvious on inspection; only on palpation

SLIDE

• Preauricular swelling (anterior to LN)
• Preauricular sinus settled by ABX

SLIDE

• Lump on one side of neck
• If not visible anteriorly, may be lateral; if not lateral may be felt on palpation

SLIDE