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Simple cases
Case 37
45-year-old man with freely movable, rubbery tumor on left shoulder
History
How long have you had this growth?
At least 10 years. When I noticed it, it was about the size of a cherry, but it has slowly grown. Now it bothers me when I lie on my back.
Good questions. The dynamics of a lesion is always important when assessing tumors.
Do you have other lumps like this one?
No; just one.
Good question. These lesions can be multiple, sometimes as part of a more generalized syndrome.
Does anyone in the family have similar lesions?
No, not that I know.
There is no increased family risk when the tumors are solitary.
Have you had any type of cancer?
Cancer - why are you asking? Is this cancer?
A lesion which has slowly grown over ten years is unlikely to be malignant. Such a question just worries a patient. If the lesion had appeared over weeks or months, a cutaneous metastasis would be a possibility.
Do you have any other health problemsdiabetes, hypertension, or elevated cholesterol?
No, but I haven't been to the doctor in 4 years.
This question does not advance the process. There is no connection between these disorders and such tumors.
Did this lesion ever bleed?
No.
Unnecessary question. Even if a subcutaneous tumor bled, the patient probably could not notice it.
Lesion
Choose the right efflorescences:
Hives are transient and multiple.
Lichenification is the result of persistent rubbing and features exaggerated skin markings. These are not seen.
This is a solid mass, > 1 cm, and represents a subcutaneous nodule.
Diagnosis
Choose the right diagnosis:
The history strongly speaks against this. Metastases often present as subcutaneous nodules but are usually not freely moveable. When in doubt, do a biopsy!
Hemangiomas are usually present at birth or soon thereafter. Even when they are deep, one can usually see some surface vessels.
Good: The history and the clinical examination are typical for lipomas, benign fat tissue tumors.
The only large xanthomas are tuberous xanthomas and they typically are associated with tendons, especially the Achilles tendon. They also have a yellow color in most cases.
Therapy
Choose the right therapy(ies):
Absolutely wrong! Lipomas are not sensitive to radiation therapy and the long-term side effects would still appear.
Since lipomas are harmless, no treatment is needed unless they are painful or cosmetically disturbing.
A lipoma is too deep to be effectively treated in this way.
Excision
Test
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