Question

A 45-year-old patient presents with swelling in the axillary region.
How will you manage this patient?

Hint:

Ensure timely referral and follow-up for suspected malignancies. Early diagnosis and treatment of infections and benign lesions can prevent complications and improve patient outcomes.

Answer 1

Step 1: Management of Infection.
- Abscesses or Infections: If the axillary swelling is due to an abscess or localized infection (e.g., hidradenitis suppurativa), initiate antibiotic therapy based on culture results. Incision and drainage (I&D) may be necessary for abscesses.
- Lymphadenitis: If the swelling is due to lymphadenitis, treat the underlying infection with appropriate antibiotics, considering the patient's risk factors (e.g., immunocompromised).

Step 2: Management of Benign Conditions.
- Lipomas or Cysts: If the axillary swelling is due to a benign lesion like a lipoma or sebaceous cyst, monitor the condition. Surgical excision may be performed if the lesion is symptomatic or cosmetically bothersome.

Step 3: Management of Malignancy.
- Breast Cancer or Lymphoma: If there is suspicion of malignancy (e.g., firm, fixed lymphadenopathy or associated breast mass), refer the patient for further investigation, such as a biopsy or imaging (e.g., mammography, ultrasound). Multidisciplinary management with oncology may be required.

Step 4: Follow-Up and Monitoring.
- Schedule a follow-up visit to assess the response to treatment. If malignancy is suspected, refer promptly to oncology for staging and treatment planning.

Step 5: Conclusion.
Management depends on the diagnosis. Infections are treated with antibiotics and drainage, benign conditions with observation or surgery, and malignancies with appropriate oncological care.