Home > Adults > Breast >

Axillary masses

Checked: 22-07-2022 by Vicky Ryan Next Review: 22-07-2021

Overview

A mass in the axilla can be caused by many different things, many of them not related to the breast, however current Trust referral guidelines state that they need to be referred to the NBT Breast Care Centre for a clinical examination of breast and axilla with imaging including an axillary USS, to rule out breast cancer. Although GPs can request axillary USS on ICE, requests which may be breast related or for likely lymph nodes, not thought to be lymphoma, will be bounced and sent to the Breast Care Centre.

More common differential diagnoses;

Axillary Lymph Node

Reactive
- Has the person had a viral infection recently?
- Have they had any trauma to their upper limb (including insect/animal injuries)?
- Have they had a vaccination within the last 2 weeks
- Breast implants
- Tattoos
Malignant
- Lymphoma
- Breast cancer
- Malignant Melanoma
- Other malignancies including gastric/ovarian
Infectious
- Granulomatous disease including Sarcoidosis
- TB
- HIV

Sebaceous Cyst and other skin related lesions

Accessory Breast Tissue – felt as a diffuse mass in the lower axilla. Often changes cyclically and common in pregnancy.

Benign neoplasms (rare, often related to neural tissue – schwannomas)

Post-operative changes (seroma/lymphocele)

Who to refer

The following patients should be referred to the Breast Care Centre via 2WW:

Palpable axillary lymph nodes with concerning history such as :

Previous history of breast cancer or any other cancer
Strong family history of breast cancer
Axillary lumps with breast symptoms (for eg. Nipple discharge, breast pain or breast lumps)
Persistent axillary lymphadenopathy for more than 6 weeks even if no breast symptoms

Exclusions:

Skin lesions (infected sebaceous cyst, hidradenitis suppurativa)

Within 2 weeks of a vaccination to ipsilateral arm or trauma / injury to ipsilateral limb (bite/animal scratch). Please clinically re-evaluate in 4 weeks, and if persists can then be referred.

Red Flags

Axillary masses with concerning history (see above) should be referred urgently using 2WW breast referral form.

For suspected lymphoma, please refer to haematology 2WW

For suspected skin malignancy, please refer to dermatology 2WW

For suspected TB, please refer to respiratory team

For suspected non-breast malignancy/metastatic spread, please refer to the appropriate specialist.

Before referral

History, important questions to ask;

Weight loss
Night sweats
Other systemic symptoms (especially respiratory and gastro-intestinal)
Significant PMH
Recent surgery
Recent vaccinations or trauma to the ipsilateral limb

Examination;

Check whether mass is within skin, or deep to skin and in axilla
Is there a punctum or signs of infection
Other nodal areas
Breast
Limbs, chest and back to look for suspicious skin lesions

Services

Refer to the Bristol Breast Care Centre using the 2WW referral form

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.