Axillary Symptoms

Many axillary issues are innocent and can be managed without referral to Secondary Care. Breast cancer rarely presents with axillary nodes alone. If a patient presents with axillary node(s) it is important to examine the patient to rule out other signs and symptoms, including skin changes or lumps that the patient may not have identified and that would indicate that the patient should have a USC referral.

(Details of other indications for Breast USC referral can be found under pages for Skin Changes, Nipple Symptoms, Breast Lumps and Breast Abscess).

However, the following is an indication for a USC referral:

New, unexplained axillary lump (2 cm or more in size, persisting for six weeks or more, or increasing in size)

For patients with axillary LN not suggestive of BC then consider other malignant or non-cancer causes of lymphadenopathy such as, connective tissue disease, eczema, and HIV infection. Consider other causes of axillary lumps, for example, skin lesions or accessory breast tissue.

The Modernising Patient Pathways Programme summarises best practice for managing axillary symptoms.

TF, EC, LP & JB FEB 26

Who to refer

Urgent Suspicion of Cancer Referral

New, unexplained axillary lump (2 cm or more in size, persisting for six weeks or more, or increasing in size)

Who not to refer

Those with skin cysts which are not troublesome
Those with hidradenitis. See guidance under Dermatology for Hidradenitis Suppurativa.
Patients with axillary breast tissue not suggestive of BC
Axillary pain is usually arising from the muscles in the chest wall. Patients can be reassured and given usual MSK advice. Please see further guidance re Breast Pain on RefHelp

How to refer

Edinburgh, Midlothian, and East Lothian Patients

Please refer via SCI Gateway to WGH

Western General Hospital >> General Surgery – Breast >> LI Breast – Urgent
OR
Western General Hospital >> General Surgery – Breast >> LI Breast – Non Urgent

West Lothian Patients