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70 CLINICAL INSIGHTS What to Do With Lumps and Bumps Sue Ettinger, DVM, DACVIM (Oncology) VCA Animal Specialty & Emergency Center, Wappingers Falls, New York CLINICAL INSIGHTS When a pet presents with a dermal or subcutaneous mass, the owner is often told, "Keep an eye on it." But what does that mean? Keep an eye on it for how long? How much should a mass grow before it is investigated? As a cancer specialist, I hear all too often that a mass does not "look" or "feel" malignant. The truth is that even an experienced cancer specialist (like me) cannot look at or feel a mass and know what it is. The current recommendations for working up a mass include the same generalities our clients hear: "Recommend if a mass is changing in size or appearance, or bothering the patient." 1 Again, what does this mean? What changes are clinically significant—any? All? What constitutes patient "bother"? These kinds of measures are not enough. A standard of care is needed for skin and subcutaneous masses in dogs and cats. I'll be honest, it's easy to get complacent. My oncology nurse had a pit bull, Smokey, whose medical record contained aspiration results from more than 10 lipomas. I performed and documented all those aspirations. When we found another mass, we waited to get an aspirate, because—based on appearance and Smokey's history—we assumed it was benign. When we finally tested it, the 7-cm mass over his flank turned out to be a low-grade soft tissue sarcoma. LET'S GET SPECIFIC Although Smokey's tumor was successfully removed with wide and clean margins, it highlighted for me the need for more definitive guidelines to promote early cancer detection ( Box 1 ). It is well documented that cytologic and histologic evaluations are important diagnostic tools in veterinary oncology and that obtaining a preliminary diagnosis optimizes treatment planning. The 2016 AAHA Oncology Guidelines for Dogs and Cats summarize the tools used for diagnosis, staging, and treatment of common tumor types. 2 It is also recommended to evaluate masses that are growing, changing in appearance, or irritating to the patient. 1 However, at this time, no specific guidelines exist for determining when to aspirate, biopsy, or monitor canine and feline skin and subcutaneous masses. Shutterstock.com/Edward Acker Welcome to Clinical Insights — a series of articles by Dr. Sue Ettinger, head of the Oncology Department at Animal Specialty & Emergency Center in Wappinger Falls, New York. Dr. Ettinger's mission is to promote awareness and education about cancer in pets. In these articles, she will combine her expertise in oncology with her experiences in practice to detail how clinicians can better care for cancer patients. CLINICAL INSIGHTS