Scary Lumps and Bumps: What I Learned in Vet School Versus What I Do Now

According to pet insurer Nationwide, in 2015 pet parents submitted over a million claims for more than half a million pets. Following are the top 10 medical conditions dogs visited the veterinarian for last year, and the average cost of each.

Top 10 Medical Conditions in Dogs in 2015

Condition Average Cost
1. Allergic dermatitis $210
2. Otitis externa (inflammation or infection of the outer ear canal) $153
3. Benign skin neoplasia (non-cancerous tumor) $348
4. Pyoderma (bacterial infection of the skin) and/or hot spot $122
5. Osteoarthritis $299
6. Periodontitis/dental disease $312
7. Gastropathy (stomach disease) $279
8. Enteropathy (intestinal disease) $139
9. Cystitis (bladder inflammation) or urinary tract infection $284
10. Soft tissue trauma (damage to muscles, ligaments or tendons) $229

Benign Skin Growths: To Remove, or Not to Remove?

As you can see from the list, the most expensive item to treat is a benign skin growth. The average $348 cost reflects the testing required to insure the neoplasia is non-cancerous, as well removal of the lump or bump.

(Keep in mind, these costs are averaged. Treating a skin growth in New York City will be more expensive than treating the same problem in, say, Idaho.)

Skin growths, even harmless ones, tend to be unsettling for pet parents, and sometimes they’re just plain ugly as well. Many veterinarians either recommend removal or are happy to do it if the dog’s guardian requests it.

However, my preference in most cases is to leave benign growths alone unless they’re interfering with a dog’s quality of life. I do keep a close watch on them to monitor any changes in size or appearance.

I use body charts showing the ventral and dorsal (front-to-back and side-to-side) views of a dog’s body. On the charts, I note lumps when I first see them, and briefly describe their appearance — size, color, etc. Then I refer to my notes each time the dog comes in to determine if the growth has changed in any way.

A fine needle aspirate of the growth, during which we pull some cells out of it and send them to a pathologist for examination, is used to determine what specific type of cell is present.

It also tells us whether it’s a benign or malignant growth. As a general rule, I only remove cancerous growths. If the pathologist determines there are spooky cells present that indicate the growth is either cancerous or pre-cancerous, I recommend immediate removal.

However, if the pathology report indicates the growth is benign (no troublesome cells are present), I don’t recommend removal unless the lump is interfering with the dog’s mobility or quality of life.

When Removing a Growth Makes Sense

Sometimes a benign tumor can interfere with a dog’s range of motion, for example, when there’s a lipoma (a fatty growth) at the junction of a joint. If a dog is altering his gait in response to a growth near a joint, his body weight is shifting, which can cause compensatory changes.

In those situations, it may make sense to remove a benign growth, preferably while it’s small.

I was taught in veterinary school to recommend removal of every lump or bump. The procedure makes a profit for the veterinary clinic, and in most cases the dog’s owner is happy to have the thing gone. The downside is the expense to the pet owner, and some element of risk to the dog from the procedure.

If a growth seems to be changing in size or appearance, it should be re-evaluated. If the aspiration demonstrates there’s a high rate of mitotic cell division or there are questionable cells present, it’s time to consider removing the growth.

In most situations, removing benign growths is done for cosmetic reasons only. The dog’s guardian doesn’t like the way it looks. But there’s really no good reason to remove a benign growth on your dog just because it’s unsightly or annoying, especially if it’s not growing or changing.

The only reason I would anesthetize a patient specifically to remove a benign growth is if it is fast growing, is impinging on range of motion or quality of life or the dog is obsessing about it.

For example, not long ago one of my dogs, Violet, needed to have two masses removed. I noticed she had two small pea-sized lumps on her body. They were firm, and I could move them around under the skin. I knew they were new lumps, and I decided to monitor them.

Over a period of time, both lumps grew larger and firmer, so I did what I always recommend: I re-evaluated them. I performed a fine needle aspirate. I stained the slides myself and looked at them in-house with my microscope. I didn’t like what I saw.

The cells had a high mitotic division rate, meaning they were replicating quickly. I sent the slides out for a second opinion. The pathologist thought there could be spindle cells, which can indicate cancer. He suggested the lumps be surgically removed. In the following video, I take you step-by-step through the decision-making process involved in choosing to remove Violet’s two masses, as well as the removal surgery, from pre-op through recovery.

By Dr. Karen Becker


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