Lump on dog's lip.

I have contacted you several times about my dog, Honey. I tend to over think things, and definitely worry too much, so I apologize for this! You have been very helpful in the past and I was hoping for a second opinion on the cytology results of a recent needle aspirate that I had done on Honey.

I noticed a very small growth on the outside of Honey's bottom lip (not on gums/mucous membranes) at the beginning of November. It was whitish-pink and hard/rough. It seemed to grow so I had my vet look at it about 10 days later (11/14). She just looked at it and said it was nothing – probably a wart or cyst, and that it would go away in 6 weeks.

She had a papilloma on the inside of her lip over the summer that looked nothing like this.

By the time I went home for Thanksgiving on 11/17, it seemed to be growing even more. I went to my family’s vet on 11/19 and had it aspirated. The vet used two needles and took two samples.

The following are the results

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Microscopic Description:
The slides are of adequate staining and preservation of cellular detail with moderate hemodilution against a pale basophilic background. Cellularity is low, with a few anucleated squamous epithelial cells noted individually and in groups. Rare macrophages are seen and neutrophils also appear mildly increased reltive to the degree of hemodilution. Rare pleomorphic bacteria are seen.

Microscopic Findings:
Low cellularity specimen with well-differentiated squamous epithelial cells, mixed inflammation and bacteria.

Comment:
Cellularity is low and may not be fully representative. however, the presence of squamous debris with concurrent mixed inflammation could suggest this is a ruptured keratin-filled lesion which has incited a significant inflammatory response with a secondary bacterial infection. However, it is also possible that the squamous epithelial cells are representative of superficial contaminants. Correlation of these findings with the clinical impression of the patient is recommended, with reaspiration and/or tissue biopsy if clinically indicated.
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The vet’s advice was to “watch & wait.” She suspects it is a cyst that has “filled in” and that it is not malignant. She said generally mast cell tumors (her original concern) exfoliate well on aspiration. She also felt she got good samples on her aspiration. The lesion is rough on the outside and is growing out of the skin (it is not below the skin). It has increased in size even more since last week, and does not look like a cyst to me.

Watching and waiting is making me nervous. At the beginning of November the lump was <1mm and now it is probably 4mm. It is still really small, so I know the vets think I'm being silly (crazy). I can't keep paying for office visits just to get "advice". Honey has had two surgeries in the past year (she was spayed at the shelter when I adopted her, and then had to have a surgery to repair an abscess that resulted from that spay), and I would much prefer not to have another surgery because of the risks of anesthesia. However, more than anything I want my dog to be okay and I need more guidance to make the right decision. I don't want to put off removing this if it might be cancer.

I am considering going into my normal vet (not the one who aspirated the growth) this week to show her the pathology report. If there is anything specific you think I should ask her, I would appreciate it.

Thanks for your time.