I'd be careful with assuming "malignant" is an HPI... HPI is obtained
by the provider from the patient.
Quality is how the patient describes their complaint or the provider 'observes' it if the patient points it out... A patient wouldn't determine if it's "malignant"
From AHIMA:
http://newsletters.ahima.org/newsletters/Code_Write/2014/December/CodeWrite_History.html
"History of Present Illness: The HPI is a chronological description of the development of the patient's present illness from the first sign and/or symptom, or from the previous encounter to the present.
HPI is obtained from the patient; frequently, the patient’s own words are reflected, but is performed by the provider or qualified healthcare professional. HPI includes the following elements:
Location — An area of the body such as "Lower right leg or the site of a problem or symptom such as "scratchy throat." The patient may point to "the back of the head." The patient may indicate a symptom that is "diffused" or "localized" in one area, or indicate that the symptom is unilateral or bilateral.
Quality — The patient to describe the distinctive character or attribute of the symptom or condition. Pain or another symptom may be described as sharp, dull, throbbing, stabbing, constant, acute, or chronic. Other examples include productive/non-productive, constant/intermittent, stable/worse/improved, thick/runny, scratchy, and clear/yellow/cloudy.
Severity — The intensity, degree, or measure of the symptom or condition. Examples include "worse pain I’ve ever had," "pain is 5 on a 1 to 10 scale," "not bad," or "severe."
Duration — The length of time the patient has had the symptom or problem. Examples include "since last week," "past three days," "three years," or "last night."
Timing — The onset of symptoms, or when the symptom or problem occurs. Examples include "nocturnal," "every three hours," "worse at night," "hurts all the time," or "pain is every 30 minutes."
Context — Surrounding events or where the patient is, and/or what the patient does when the symptom or problem begins. Examples include "fell going up stairs," "left tibia fractured while playing soccer," or "only happens when I eat green peppers." Situational stress such as "anxiety only when my ex-husband is around" qualifies for context.
Modifying factors — What was done to try to fix the symptom or problem? Examples include "I applied an ice pack and it did not help," "took Tylenol and it did not touch the pain," "headache goes away when I lie down."
Associated signs and symptoms — Additional signs and symptoms. Examples include diaphoresis (marked sweating) associated with indigestion or chest pain, weakness in addition to the presenting symptom of shortness of breath, headache in addition to laceration of the right arm after fall."
From CMS:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf
" Quality (example: aching, burning, radiating pain)"
FROM CPT Assistant 1996
"Quality
The physician should encourage the patient to describe the quality of the symptom, since some diseases or conditions produce specific patterns of complaints. For example, pain may be described as sharp, dull, throbbing, stabbing, constant or intermittent, acute or chronic, or stable, improving or worsening. "