The Skin
Last updated (19 November 2003)
Good Stuff
Spot Diagnosis
Skin
Padding space Nodular
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Nodular Click on the image to download a larger version
This gentleman was referred to the outpatients by his general practioner with a subcutaneous nodule on the posterior aspect of the left calf.
What particular questions would you ask?
History of drug allergies?
History of and any problems related to anaesthesia
Progression in size
Family history of any skin conditions
History of local trauma/penetrating injury

The answer

All of the above points are important on taking the history.

What the student may say

It would be important on the history to ask about how long the nodule had been present? Was the nodule increasing in size? (If the nodule has been present for many years with no change then it is much less likely to indicate a malignancy). Was there any history of trauma or a penetrating injury? (Area of fat necrosis, Possible foreign body). Was it painful? What trouble was it causing? (If the nodule is not causing any trouble it may be best to not advise excision)

A past history of any operation and anaesthetics is important, as the patient may need a further operation. Any problems with previous operations or anaesthetics are important as they may indicate possible problems if further surgery is required.

A family history of multiple lipomas (Decrum's disease) or neurofibromatosis (Von Recklinghausen's disease), may indicate the possible aetiology. Any family history of malignancy should lower the threshold to advise excision. Similarly a family history of problems under anaesthesia is important.

Adrian P. Ireland