Differential diagnosis and management of neck lumps

Neck lumps are common. One of the most important considerations in an adult presenting with a lateral neck lump is that it may represent a metastatic lymphadenopathy from a carcinoma of the upper aerodigestive tract. This is particularly true for patients aged >40 years and if they smoke and drink heavily; diagnosis of the primary tumour must be made without delay in these patients. Diagnosis must be made without an open biopsy of the mass because the oncological outcome may be compromized.Patients with neck masses should be referred to an appropriate clinician. An accurate history should be taken and a thorough examination of the head, neck and upper aerodigestive tract done. Examination of the latter should include fibreoptic nasolaryngoscopy, which allows the nasal cavity, nasopharynx, larynx, upper trachea and hypopharynx to be seen.Fine-needle aspiration cytology/biopsy with or without ultrasound has revolutionized the management of neck lumps because the cytologist can provide or suggest the diagnosis.