By Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD and Dr Peter Swan MBChB, FRACS
Compass Surgical | MacMurray Centre, Auckland
This is Article 2 of 8 in our guide to skin lumps, bumps and minor surgical procedures.
In our first article, What Are Common Skin Lumps and Bumps?, we discussed some of the most common causes of lumps beneath the skin, including cysts, lipomas, skin tags and other benign lesions.
One of the next questions patients often ask is:
“How do you actually know what the lump is?”
Fortunately, many lumps can be diagnosed through a careful history and examination. In some situations, additional investigations such as ultrasound scans or biopsies may be helpful to confirm the diagnosis and guide treatment.
The goal is not simply to identify a lump.
The goal is to understand exactly what it is and whether any treatment is required.
Often, yes.
Many common lumps have characteristic features that become apparent during examination.
For example:
In many cases, an experienced surgeon can make a likely diagnosis during the consultation.
However, not every lump is straightforward, and sometimes further investigation is appropriate.
The history of the lump is often just as important as the examination itself.
Questions commonly include:
These answers help narrow down the possible diagnosis and determine whether further investigation may be useful.
Ultrasound is one of the most useful investigations for soft tissue lumps.
It can help determine:
For many patients, ultrasound provides reassurance and helps guide treatment planning
No.
Many lumps can be diagnosed confidently through clinical assessment alone.
However, imaging is often helpful when:
Scans should support a clinical assessment rather than replace one.
More advanced imaging is occasionally required.
MRI scans can be particularly useful for:
Fortunately, most patients never require this level of investigation.
A biopsy involves taking a small tissue sample for microscopic examination.
Depending on the situation, this may involve:
The tissue is then examined by a pathologist, who provides a definitive diagnosis.
No.
Many benign lumps can be diagnosed confidently without a biopsy.
However, when there is uncertainty, tissue diagnosis can provide important information and help guide treatment decisions.
For some lumps, complete removal is both the treatment and the method of establishing a final diagnosis.
Whenever a lump or skin lesion is removed, it is usually sent for pathological examination.
This allows:
For most patients, pathology simply confirms a benign diagnosis and provides reassurance.
At Compass Surgical, we believe accurate diagnosis is the foundation of good surgical care.
Our approach is built around:
Working within the multidisciplinary environment of the MacMurray Centre allows us to collaborate closely with GPs, radiologists, dermatologists and other specialists when additional assessment is needed.
Whether a lump requires reassurance, investigation or removal, our goal is to provide clear answers and personalised advice.
Once a diagnosis has been established, the next question is often:
“Do I actually need surgery?”
Many lumps can be monitored safely, while others are best removed because of symptoms, growth, uncertainty or cosmetic concerns.
In the next article, “Do I Need Surgery for My Lump or Bump?”, we’ll discuss how surgeons help patients decide whether removal is necessary and what factors influence that decision.
If you’re concerned about a lump or would like specialist advice, you can learn more about our skin lesions and soft tissue lump services or book a consultation with Compass Surgical.
Do all lumps need an ultrasound?
No. Many can be diagnosed clinically, although ultrasound is often useful when the diagnosis is uncertain.
Can you tell if a lump is cancer without a biopsy?
Sometimes a lump appears reassuring, but a biopsy is occasionally required to establish a definitive diagnosis.
What is the best scan for a lump?
Ultrasound is often the first investigation. MRI may be useful for selected deeper or more complex lesions.
Will every lump that is removed be sent to pathology?
In most situations, yes. Pathological examination confirms the diagnosis and provides reassurance.
Should I see a surgeon even if I think the lump is benign?
If a lump is growing, symptomatic, changing or causing concern, an assessment is usually worthwhile.
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Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD
Dr Thomas Hanna is a general and transplant surgeon practising in Auckland. He trained in the United Kingdom before moving to New Zealand in 2019. He has specialist interests in gallbladder surgery, hernia repair, minimally invasive surgery and complex abdominal surgery. Tom is a founding partner of Compass Surgical and is committed to patient-centred surgical care, clear communication and surgery performed with integrity.
Dr Peter Swan MBChB, FRACS
Dr Peter Swan is a general surgeon practising in Auckland with expertise in gallbladder surgery, hernia repair and general surgical conditions including lumps and bumps. He is a founding partner of Compass Surgical. Peter’s practice focuses on practical, evidence-based advice, careful patient selection and personalised treatment.
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