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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