{"id":1638,"date":"2021-01-05T11:55:00","date_gmt":"2021-01-05T15:55:00","guid":{"rendered":"https:\/\/www.drphilzeltzman.com\/blog\/?p=1638"},"modified":"2022-07-11T11:13:49","modified_gmt":"2022-07-11T15:13:49","slug":"4-things-you-should-never-say-or-hear-about-lumps","status":"publish","type":"post","link":"https:\/\/www.drphilzeltzman.com\/blog\/4-things-you-should-never-say-or-hear-about-lumps\/","title":{"rendered":"4 things you should never say or hear about lumps"},"content":{"rendered":"\n

Removing skin masses is one of my most common surgeries.<\/p>\n\n\n\n

\"A<\/figure><\/div>\n\n\n\n

Some skin masses are small. Some are in difficult locations, making the surgery tricky. Some are gigantic. Many were claimed to be \u201cimpossible to remove\u201d \u2013 yet we still removed them. Some were supposed to be cancerous \u2013 and were benign. Some were supposed to be benign \u2013 and were cancerous. Yet others were indeed impossible to remove and required leg amputation.<\/p>\n\n\n\n

What\u2019s a pet lover to do? What is the right thing to do?<\/strong><\/span><\/p>\n\n\n\n

The problem with small skin masses is that they can be very misleading. I have come across multiple tiny masses, sometimes the size of a grain of rice, that were aggressive cancers.<\/p>\n\n\n\n

Here is an example of a 1\/3 inch mass, barely visible, hard to feel, under a cat\u2019s fur. By some miracle, his owner found the mass and wisely decided to have it removed.<\/p>\n\n\n\n

\"A<\/figure><\/div>\n\n\n\n

The biopsy revealed a fibrosarcoma, which is a notoriously aggressive cancer in cats.<\/p>\n\n\n\n

Here are the 4 things you should never say or hear about lumps:<\/span><\/strong><\/p>\n\n\n\n

. \u201cJust watch it.\u201d<\/p>\n\n\n\n

. \u201cKeep an eye on it.\u201d<\/p>\n\n\n\n

. \u201cIt\u2019s just a cyst.\u201d<\/p>\n\n\n\n

. \u201cIt\u2019s just a fatty tumor.\u201d<\/p>\n\n\n\n

\u201cJust watching\u201d a mass grow bigger and bigger, or \u201ckeeping an eye\u201d on a mass that keeps getting larger and larger, is exactly how we end up with masses the size of pumpkins.<\/p>\n\n\n\n

By then, surgery is much more invasive, anesthesia is much longer, and the fees are much higher.<\/p>\n\n\n\n

The \u201ccyst\u201d myth is just as unfortunate. A cyst is an actual diagnosis. It\u2019s typically a benign mass that is usually filled with fluid. There are different types of cysts: follicular or epidermoid cysts, sebaceous cysts, dermoid cysts etc.<\/p>\n\n\n\n

But the vast majority of so-called \u201ccysts\u201d I remove are not cysts. It was an assumption by the pet owner. \u201cCyst\u201d is often used instead of \u201cmass\u201d or \u201ctumor,\u201d and it\u2019s misleading at best.<\/p>\n\n\n\n

\u201cIt\u2019s just a fatty tumor\u201d is something else I hear all the time. If someone tells you that, you should have a reasonable degree of doubt. NOBODY can assure you with 100% certainty that they know the diagnosis of a mass with further testing.<\/p>\n\n\n\n

Why? Because I have never met anybody with microscopic vision.<\/p>\n\n\n\n

You can only say what a mass is after testing it.<\/p>\n\n\n\n

Case in point: a mast cell tumor is a very common skin tumor. It is nicknamed \u201cthe great imitator\u201d because it can feel like anything \u2013 including a benign fatty tumor. As you can imagine, mistaking a benign tumor for a cancerous one can lead to really frustrating situations.<\/p>\n\n\n\n

2 tests for skin masses:<\/span>
There are 2 ways to test a mass.

1. A needle test:
<\/span>During a needle test or Fine Needle Aspirate (or FNA), a needle is placed in the mass. Some cells are taken out and placed on a glass slide. It is then read under the microscope.
It can either be read \u201cin house,\u201d meaning by your vet, or ideally it is sent out to a pathologist, who reads the cytology (ie the study of cells).
My personal impression is that although cytology is cheaper and faster (a few days), it can provide misleading results.

2. A biopsy:
<\/span>A biopsy is a way to take a sample of the mass, ie some actual tissue, and not just cells. Being able to study the cells\u2019 architecture, organization and relationship provides completely different information and a much safer diagnosis.
The biopsy is always sent to a pathologist, who reads the histo-pathology (ie the study of abnormal tissue).
My personal impression is that although a biopsy cytology is more expensive and take longer to read (7-10 days), it provides the most reliable results.<\/strong><\/td><\/tr><\/tbody><\/table>

<\/figcaption><\/figure>\n\n\n\n

So what\u2019s a loving pet owner to do?<\/span><\/strong><\/p>\n\n\n\n

At a minimum, skin masses should get tested via a needle test. Occasionally, they should be biopsied before surgery. Ideally, they should be removed and biopsied. Admittedly, it can get expensive since some dogs seem to be covered in masses, sometimes benign fatty masses. That\u2019s where pet insurance is so helpful.<\/p>\n\n\n\n

Here is an example of a giant mass in a Lab, whose owner was told to \u201cjust watch it\u201d because it was tested as a benign fatty tumor.<\/p>\n\n\n\n

\"A<\/figure>\n\n\n\n

So why bother if a mass is benign?<\/p>\n\n\n\n

Benign doesn\u2019t mean you should ignore it.<\/p>\n\n\n\n

I have removed benign masses that were the size of a tennis ball, or a grapefruit, that prevented the patient from walking normally. I have removed benign masses that required leg amputation. And I have removed benign masses that were the size of a pumpkin that caused pain (by stretching the skin) and made the patients lose their balance.<\/p>\n\n\n\n

If you find yourself in a situation where your vet seems to be brushing something off that genuinely concerns you, you have the right to seek a second opinion and I would encourage you to do so.<\/p>\n\n\n\n

Bottom line: waiting is rarely a wise option.<\/p>\n\n\n\n

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Removing skin masses is one of my most common surgeries. Some skin masses are small. Some are in difficult locations, making the surgery tricky. Some are gigantic. Many were claimed to be \u201cimpossible to remove\u201d \u2013 yet we still removed them. Some were supposed to be cancerous \u2013 and were benign. Some were supposed to […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[87,263,91,262,157,48,156],"class_list":["post-1638","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-benign-mass","tag-lumps","tag-mass-removal","tag-masses","tag-phil-zeltzman","tag-tumor","tag-veterinary-surgeon"],"yoast_head":"\n4 things you should never say or hear about lumps | Dr Phil Zeltzman\u2019s Blog<\/title>\n<meta name=\"description\" content=\"Some skin masses are small. 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