prescribed only for fibrocystic disease in adolescence Follow-up and subsequent evaluation by a primary care physician is recommended; referral to a surgeon for needle aspiration or core biopsy is indicated for painful, large, solitary lesions Nipple masses represent another group of generally benign breast lesions Benign intraductal papillomatosis is the most common etiology and can be seen in prepubertal or pubertal boys and girls, often coming to attention because of bleeding from the nipple Occasionally, the lesion may obstruct the nipple and causing pain and possibly infection In extremely rare instances, a nipple mass can represent an intraductal carcinoma In these cases, cytologic examination of the bloody nipple discharge can be of diagnostic value Therefore, expedient referral to a breast surgeon or pediatric surgeon is indicated after detection of nipple mass with bloody discharge In cases of benign nipple masses, careful observation for several weeks by an experienced primary care physician or surgical specialist is indicated If the nipple mass or bleeding persists, excision is the treatment of choice Trauma to the breast can lead to hematomas and fat necrosis, both of which are palpated as firm, lumpy, well-circumscribed breast masses Initially, these lesions may be tender If left untreated, they may develop into areas of scar tissue that are affixed to the skin Fat necrosis is relatively common, but the differentiation from other more serious lesions may be difficult, requiring consultation with a surgeon or use of serial ultrasounds in cases of uncertainty Malignant Masses Primary cancers of the breast have been reported in children, but are exceedingly rare, with an incidence of in 1,000,000 females less than age 20 years In children, breast tumors accounting for less than 1% of all malignancies and less than 0.1% of all breast cancers occur in the pediatric age group Metastatic disease is far more common than primary breast tumors, and may be secondary to Hodgkin and non-Hodgkin lymphoma, neuroblastoma, and leukemia, and rhabdomyosarcoma Adolescent or childhood breast tumors are often classified as secretory carcinomas that behave more benignly than breast cancers in adults Other histologic classifications of breast malignancies reported in children and adolescents include carcinomas, sarcomas, and cystosarcoma phyllodes, which can have both benign and malignant features Physical examination characteristics suggestive of malignancy include a hard, nontender, solitary mass with ambiguous margins The mass may be fixed to surrounding tissues, and overlying skin changes such as edema, warmth, skin dimpling, and/or nipple retraction may be present Other signs include bleeding from the nipple and local lymphadenopathy may be present The appropriate treatment for suspected