Breast lumps

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Refer urgently

  • Any new discrete lump in patients 30 years and over
  • New asymmetrical nodularity that persists at review after 2 or 3 weeks (in patients over 35)
  • Unilateral isolated axillary lymph node in women persisting at review after 2 to 3 weeks
  • Recurrent lump at the site of a previously aspirated cyst
  • Nipple eczema if not responsive to 2 weeks of moderately potent topical steroid
  • New unilateral nipple retraction
  • Skin tethering/fixation/ulceration/paeu d'orange
  • Mastitis which does not settle or recurs after one course of antibiotics

Refer routinely

  • Any new discrete lump in patients under 30 with no other suspicious features
  • New asymmetrical nodularity that persists at review after 2 or 3 weeks (in patients over 35)
  • Persistent unilateral spontaneous discharge sufficient to stain outer clothes (see nipple discharge pathway)

Primary care management

  • Women with longstanding tender lumpy breasts and no focal lesion
  • Tender developing breasts in adolescents
  • Longstanding nipple retraction
  • Nipple eczema if eczema present elsewhere
  • Obvious simple skin lesions such as epidermoid (sebaceous) cysts

Editorial Information

Last reviewed: 30/08/2022

Next review date: 30/08/2024

Reviewer name(s): Maria Bews-Hair.