Neck Mass

Question 1

Should you treat a neck mass with antibiotics?

Answer 1

You should NOT routinely prescribe antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection.

Source: AAO-HNS Clinical Practice Guideline for Neck Masses

Question 2

When should you be suspicious of a neck mass in an adult?

Answer 2

1) You should identify patients with a neck mass who are at increased risk for malignancy when the patient lacks a h/o infectious etiology and the mass has been present for >/= 2 weeks without significant fluctuation, or the mass is of uncertain duration.
2) 80% of these neck masses are malignant
3) Such a mass should be considered malignant until proven otherwise

Question 3

Neck Mass - Suspicious physical exam findings.

Answer 3

Patients with a neck mass who are at increased risk for malignancy - base this determination on >/= 1 of these physical exam characteristics:
1) Fixation to adjacent tissues
2) Firm consistency
3) Size >/= 1.5cm
4) Ulceration of the overlying skin

Question 4

Neck Mass - Stand Alone Characteristics Suspicious For Malignancy

Answer 4

1) Absence of infectious etiology - absence of recent infection
2) Mass present > 2 weeks or of uncertain duration: a persistent mass is more likely to be malignant
3) Reduced mobility of neck mass
4) Firm texture of mass: malignant neck masses are often firm; fluid filled cystic masses may also be malignant
5) Neck mass size > than 1.5cm
6) Ulceration of the skin overlying the neck mass

Question 5

Neck Mass - Additional characteristics of history and physical exam suspicious for malignancy.

Answer 5

1) Age > 40 years
2) h/o Tobacco and alcohol use
3) Throat pain - may indicate mass/ulceration of the upper aerodigestive tract
4) Dysphagia
5) Ipsilateral otalgia with a normal ear exam: may represent referred pain from the pharynx; unilateral otitis serous otitis media may result from ET obstruction from a NP malignancy
6) Oral cavity or oropharyngeal ulcer
7) Recurrent voice change
8) Recent hearing loss
9) Recent hearing loss/ipsilateral neck mass
10) Nasal obstruction and epistaxis ipsilateral to the neck mass
11) Unexplained weight loss
12) H/O treatment for H/N malignancy including skin, salivary gland, or aerodigestive sites
13) Non tender neck mass
14) Tonsil asymmetry
15) Skin lesions (face, neck, scalp included)

Question 6

How to follow-up a patient with a neck mass who is not at increased risk of malignancy.

Answer 6

1) Have the patient check the size of the mass - instruct them to return for a f/u evaluation if the mass gets larger
2) Return for the following:
- Difficulty swallowing or pain with swallowing
- Neck or throat pain
- Mouth sores or tooth pain
- Ear pain or hearing loss on the same side as the mass
- Voice change
- Fever >/= to 101