Measuring the size of surface masses by inspection and palpation

In patients presenting with surface masses as chief complaint, the physicians assessing the masses should include measurement of the size through inspection and palpation.  Surface masses are those located on the skin and those beneath the skin but not within any body cavity like the cranial, thoracic and abdominal cavity.  The surface masses should at least be palpable by the examining fingers for the physicians to be able to measure them.  Surface masses beneath the skin may not have accompanying gross extension on the skin. Thus, reliance is placed on palpation to measure the masses. Masses that can be seen on the skin surface are measured with the help of both inspection and palpation.

Physical measurement of surface masses is at best an estimation.   However, the estimation must be systematically done so as to approximate the real size.

Physical measurement can be done using a caliper, tape, ruler, or mental estimation.  The caliper is supposed to have the best estimation results.

Mental estimation is done by having a mental visualization of the size of the mass.  Before one can do a mental estimation, one should be familiar with the actual length of one centimeter, two centimeters, three centimeters, and so forth and so forth.  If one feels and sees the length of the mass, he can make a mental estimation of its size in centimeters.  One feels the length of the mass by initially determining the borders of the mass in one dimension, then place the fingers at the two ends of the dimension and then make a mental estimation in centimeters.

Illustrations are shown below that facilitate mental estimation.

IMG_7357

Noting the actual length of a centimeter, 2 cm, 3 cm, etc.

IMG_7358

For example, a palpating finger size is about 1.5 cm for this physician.

IMG_7361

Two palpating fingers – about 3 cm.

IMG_7363

Three palpating fingers – about 4.5 cm to 5 cm.

 

 

IMG_7366

Four palpating fingers – about 6 to 6.5 cm.

IMG_7367

Putting 2 fingers to feel the borders of the mass and then estimating the size.  In this case, about 5 cm.

IMG_7369

Putting 2 fingers to feel the borders of the mass and then estimating the size.  In this case, about 4 cm.

IMG_7370

Putting 2 fingers to feel the borders of the mass and then estimating the size.  In this case, about 3 cm.

IMG_7372

Putting 2 fingers to feel the borders of the mass and then estimating the size.  In this case, about 2 cm.

NOTE: If there is a need to be more accurate in the estimation of the size of the mass using inspection and palpation, use caliper.  If caliper is not available, use tape measure.

IMG_7373

Mass on the forearm. Border of the mass outlined.  Mental estimation – 2 cm.

IMG_7374

Measurement by ruler – 2 cm.

IMG_7380

Seborrheic Keratosis on the thigh.  Mental estimation: less than 1 cm – about 5-6 mm.

IMG_7383

Ruler measurement – 5 cm.


ROJ@18aug26

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