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Neck Lumps or Masses

The important concepts in understanding neck lumps are : age, location, solitary or multiple, duration and associated symptoms.

Age
The vast majority of lumps in children will be either inflammatory or congenital. Single lateral neck lumps in an adult over 40 must be considered cancerous until proven otherwise.

Location


Subcutaneous
 - sebaceous cyst, epidermoid cyst

Midline lumps - these are often congenital i.e. present at birth at least in vestigial form. Under the chin they may represent dermoid cysts, thyroglossal cysts (especially around the hyoid). In the lower neck they may represent thyroid abnormalities and will elevate with swallowing.

Angle of jaw - most of these are parotid lumps. Most are benign parotid tumours but lymph nodes involved by skin cancer occur increasingly with age.

Under the body of the mandible
 - usually related to abnormalities of the submandibular gland such as blocked gland, infection, tumour. As with parotid lumps, lymph nodes involved by skin cancer occur increasingly with age. In Polynesian patients in particular, a cystic swelling may be due to a "plunging ranula" which is due to chronic leakage of mucus from the sublingual gland (under the tongue) into the neck. Lumps in the lower neck in front of or deep to the neck muscles often represent thyroid abnormalities and will elevate with swallowing. Most thyroid lumps are benign but still require investigation as some are cancers.

Lateral neck
 - usually are enlarged lymph nodes. Any persisting lateral neck lump in an adult must be treated with suspicion for malignancy. Other possibilities include nerve tumours, carotid body tumours.

Number

Multiple lumps are generally lymph nodes and the most common cause is inflammation e.g. glandular fever, toxoplasmosis. However multiple non-tender nodes can be due to malignancy either primarily of lymph nodes (lymphoma) or secondarily by spread from a cancer of the head and neck.


Duration

Generally lumps that have been present for years are benign but not necessarily so e.g. parotid or thyroid cancers can be quiescent for years before taking on a more aggressive course. Most inflammatory lumps will begin to resolve within 3 weeks. Any lumps that are persisting or growing over a few weeks or months must be investigated for malignancy.


Associated symptoms

Inflammatory nodes are generally associated with systemic symptoms such as tenderness, fever, malaise, sore throat. Serology for glandular fever or toxoplasmosis may be positive. Lymphomatous nodes can have similar symptoms of fever, night sweats, weight loss, and tenderness. Any nodes that persist for more than 3 weeks in the absence of a diagnosis should be investigated. Lateral neck nodes in adults may be metastases from the throat. These patients may be heavy smokers and may experience throat or ear discomfort, voice change or swallowing difficulty. Some will have a past history of skin cancers.

Location Information

Contact Details

Phone (09) 367 0000

Patient enquiries:  (09) 375 4300

Known extension/pager:  (09) 307 4949

Admission & Planning Unit:  Ext 24210 / 23225 | Fax: (09) 375 7038

Acute Referrals Service:  (09) 375 7030, Ext: 24048 |Fax: (09) 307 2858

Outpatient appointments & surgical booking enquiries: (09) 638 0400

Mental Health Services

24 Hour Crisis Line:  0800 800717

GP / External Specialist Help Desk: (09) 307 2800

Street Address

2 Park Road
Grafton
Auckland 1023

Postal Address

Private Bag 92 024
Auckland Mail Centre
Auckland 1142

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