Lump examination

Here is a photo of a young Gordon Brown. Not so dour back then, was he?

What a whopper!

You will often need to examine and describe lumps, bumps and masses, in Dermatology, in Gastroenterology and many other situations.

Below is a concise way to do it.

The Mnemonic

She Cuts The Fish PERfectly

What that means

Three Ss

• Site - describe location briefly
• Size - use your hand and fingers to estimate if you do not have a ruler with you
• Surface/overlying skin

Three Cs

• Colour
• Contour - is the lump well-defined or irregular
• Consistency - ?soft/firm/hard

Three Ts

• Tenderness
• Temperature - Is it hot/inflammed?
• Transilluminable

Three Fs

• Fluctuance - ?fluid-filled cyst
• Fixity - ?is it fixed to the underlying tissue or to the overlying skin
• Fields - draining lymph glands in the area

Finally, remember to check for whether the lump is:

1. Pulsatile (Is it an aneurysm?)
2. Expansile (Is it an aneurysm?)
3. Reducible (Is it a hernia?)

A demonstration

The younger Gordon Brown has generously offered to be our model for the purposes of demonstrating this mnemonic. We will now describe the lump on his face (his nose).

The lump is situated centrally, on the front of the face, between the eyes. In size it is around 15 cm tall, 6 cm wide and protrudes around 4cm. The skin covering it is normal in colour and texture.

The lump is the same colour as the surrounding face, with severely angular contours and a centrally hard consistency, with softer areas either side.

It is not tender to palpation, nor different in temperature to surrounding areas. The soft parts on either side are thin and transilluminable.

It is not at all fluctuant, and is clearly fixed centrally to the underlying tissue. No enlarged lymph glands in the surrounding field.

It is not pulsatile, nor expansile, and Gordon gives out a dissatisfied grunt when one attempts to find out it if is reducible.