differences between a malignancy and gynaecomastia:
The first step in clinical evaluation of patients consists of differentiating gynecomastia from other causes of enlarged breast tissue or mass (1).
Physical examination in male breast enlargement: (1,2)
  | Malignancy  | 
Bilateral (usually) or unilateral  | Unilateral (usually) or bilateral (rarely)  | 
Painless or painful (occasionally)  | Painless or painful (uncommon)  | 
Central (subareolar)  | Central (70-90%) or eccentric*  | 
Smooth  | Irregular*  | 
Firm  | Rubbery or hard*  | 
Mobile  | Fixed*  | 
Normal nipple  | Nipple deformity (17-30%) or discharge (<10%)*  | 
Normal skin  | Thickened, red, or ulcerated skin*  | 
Normal axilla  | Axillary adenopathy**  | 
*mandates surgical evaluation.
**may be associated with locally advanced malignancy
Reference:
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