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Increasing size Size greater than 5 cm (ie, golf-ball size) Deeper-lying mass (deep to fascia) Firmer than surrounding tissue Patient has potential risk factors (previous radiotherapy, chronic lymphedema, inherited syndrome such as Gardner syndrome, Li-Fraumeni syndrome, and von Recklinghausen disease) Local symptoms and signs of infiltration With or without pain (large painless lumps should raise concern) The greater the number of clinical features, the greater the risk of malignancy.