Ultrasound emerges as crucial tool in diagnosing pediatric bumps and lumps

Dr. Jérôme Coulombe

When children present with unexplained bumps or masses on their skin, Doppler ultrasound is increasingly becoming the first line of defense in the diagnostic process, according to Dr. Jérôme Coulombe and reported in the April/May issue of The Chronicle of Skin & Allergy.

At the annual pediatric dermatology update held at St. Justine, Dr. Coulombe, Associate Professor at the University of Montreal and St. Justine Hospital, underscored the clinical advantages of Doppler ultrasound, highlighting its ability to assess the size, shape, location, internal content, and vascularity of pediatric skin lesions. “Doppler ultrasound is your best friend,” Dr. Coulombe said, while also acknowledging that discrepancies can arise between clinical and radiological findings. “When this happens, consult your colleagues and/or get a skin biopsy.”

Diagnosing nodules, bumps, or lumps in children remains a complex challenge for clinicians. Dr. Coulombe said such lesions typically fall into one of four categories: cysts, vascular lesions, inflammatory dermatologic presentations, or tumours, which may be benign or malignant. “The majority of them [lumps or bumps] will be benign,” he noted.

Clinical evaluation remains the cornerstone of diagnosis. Dr. Coulombe described several features that can help distinguish benign from malignant lesions. Benign bumps and lumps often have a ruby colouration, as seen in hemangiomas, may exhibit a Darier sign indicative of a mast cell tumour, or present a “tent” appearance characteristic of dermatofibromas. Other benign entities include lipomas, vascular malformations, boils, abscesses, or infections.

Conversely, Dr. Coulombe cautioned that certain warning signs should prompt further investigation. “Symptoms and signs of borderline or malignant bumps or lumps include neonatal onset, rapid growth, pain, ulceration, and bleeding, size that exceeds more than three cm, and onset in an immunosuppressed patient,” he said.

After the initial assessment, if a lesion’s features are concerning, Doppler ultrasound can further characterize its nature and help determine if the lesion is benign or potentially malignant. In cases where ultrasound is inconclusive, additional imaging such as MRI or CT scans, or even biopsy, may be warranted. “It may have to be referred for surgery [excision],” Dr. Coulombe added.

A longer version of this news article was published in the April/May edition of The Chronicle of Skin & Allergy, which is marking its 30th anniversary of continuous publication. With files from Louise Gagnon, Chronicle contributor