Diagnosis and management of neck lumps

Neck lumps are a challenging proposition for any surgeon. They also form a substantial component in clinical examinations for higher surgical diplomas. This is because many different diagnostic possibilities exist in a relatively small area. It is a good presumption, especially in an adult, that a neck lump represents malignant disease until proven otherwise which might be arising from an occult primary in the nose, throat or oral cavity. Lesions in these areas might not be readily visualized and so part of the assessment should include an ENT opinion. A thorough history and examination provide important clues to elucidating the cause. This provides for directed imaging and finally biopsy/excision if required. Excision of a malignant lump in isolation can in some circumstances reduce patient survival if any associated primary is not recognized and dealt with, but worse is an incisional biopsy which should only be undertaken as a very last resort as there is a risk of seeding tumour through the neck.A good working knowledge of the anatomy of the neck, a systematic approach to examination of the area and an appreciation of the possible differential diagnoses are vital to acquiring a safe, efficient and effective management strategy.