Subcutaneous Masses: Should You Remove Without Imaging?

Elongated mass

Hello, doctor.
There is a slender lump located at the angle between the bottom of my thigh and the perineum, with one end feeling connected to the buttock and the other end feeling disconnected from any other part.
The entire lump is mobile under the skin, with a diameter of about 6mm-8mm and a length of approximately 30mm.
It has been present for 2-5 years and has recently experienced two episodes of swelling and discomfort, both of which resolved on their own back to the original size.
Recently, I visited a plastic surgeon who arranged for a CT scan and scheduled a follow-up appointment to review the results.
I would like to ask you if it is appropriate to directly remove the lump for pathological examination without undergoing the CT scan.
Would making such a request be difficult for the physician in a medical practice? Thank you.

123, 40~49 year old female. Ask Date: 2023/02/07

Dr. Chen Ronghong reply Surgery

Hello, your request can be discussed with the physician.
If the physician determines through palpation that the mass is confined to the subcutaneous tissue, then direct surgical removal is feasible.
However, if the physician believes that the subcutaneous mass is just the tip of the iceberg, then a CT scan (or ultrasound) may be necessary.

Reply Date: 2023/02/07

More Info

When it comes to subcutaneous masses, particularly those that have been present for an extended period, such as the one you described in the thigh and perineal area, there are several important considerations to keep in mind before deciding on a course of action, such as surgical removal without prior imaging.

Firstly, the characteristics of the mass you described—its size (6mm-8mm in diameter and 30mm in length), its mobility, and the fact that it has been present for 2-5 years—are significant. The fact that it has recently caused discomfort but has resolved on its own may suggest that it is benign, but it does not eliminate the need for further evaluation. In clinical practice, the history of the mass, including any changes in size, consistency, or associated symptoms, is crucial in determining the next steps.

Imaging studies, such as a CT scan, can provide valuable information about the mass's nature, its relationship to surrounding structures, and whether there are any concerning features that might suggest malignancy or other complications. For instance, imaging can help differentiate between a simple lipoma (a benign fatty tumor), a cyst, or a more complex lesion that may require a different approach. In your case, the decision to obtain a CT scan before proceeding with surgery is a prudent one, as it allows for a more informed surgical plan.

If you are considering requesting the removal of the mass without imaging, it is essential to communicate openly with your surgeon. Surgeons often prefer to have imaging studies to guide their approach and ensure that they are not missing any underlying issues that could complicate the procedure. While it is not uncommon for patients to express a desire for immediate action, it is also important to respect the medical professional's recommendations based on their training and experience.

In terms of whether your request would be difficult for the physician, it largely depends on the individual surgeon's practice style and the protocols of the medical facility. Some surgeons may be open to performing the procedure without imaging if they feel confident in the clinical assessment, while others may insist on imaging to mitigate risks and ensure the best possible outcome.

In summary, while it is understandable to want to proceed with the removal of the mass, it is advisable to follow the recommended protocol of obtaining imaging first. This approach not only aids in ensuring a safe and effective surgical outcome but also provides peace of mind regarding the nature of the mass. If you have concerns about the imaging process or the necessity of it, discussing these openly with your surgeon can help clarify the rationale behind their recommendations and ensure that you are comfortable with the planned approach. Ultimately, the goal is to ensure your health and safety while addressing the issue at hand.

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