What initial investigations should be performed for a patient presenting with a painless scrotal lump?

Initial investigations for a patient presenting with a painless scrotal lump should include a direct access ultrasound scan of the scrotum. This is recommended to assess the nature of the lump and to exclude testicular cancer or other significant pathology.

If the ultrasound is suspicious or shows testis enlargement, change in shape or texture, or other concerning features, the patient should be considered for a suspected cancer pathway referral.