Synopsis
Develop the ability to localise an axillary lump to lymph node, skin, accessory breast or soft tissue and use breast, systemic and infective features to direct urgent investigation, while explaining uncertainty and arranging reliable review.
- Decide first whether the axillary lump is a lymph node, skin lesion, abscess, lipoma, vascular structure or hormonally responsive accessory breast tissue.
- Ask about breast symptoms, melanoma or other cancers, fever and weight loss, recent vaccination, upper-limb wounds, shaving, hidradenitis and pregnancy or lactation.
- Examine the lump’s depth, tenderness, mobility and skin relation, then assess both breasts, upper limbs, supraclavicular fossae and other nodal stations.
Investigation priorities
Distinguish a lymph node from a superficial or soft-tissue mass and evaluate cortical and hilar morphology.
Management branches
A 62-year-old has a hard 2 cm left axillary lump, no breast symptoms and no recent vaccination or infection; breast palpation is normal.
- Map the axillary lesion and examine breasts, supraclavicular areas, skin and upper limb, while asking about systemic symptoms, prior cancers, infection and immunisation.
- Arrange urgent breast-service assessment because an unexplained axillary lump in an adult can represent occult breast cancer or another malignancy despite normal breast palpation.