When Should I See A Neck Lump Specialist?

All lumps in the neck must have a diagnosis! A specialist review at our One Stop Neck Lump Clinic at 86 Mauranui Clinic in Epsom, Auckland will allow a diagnosis and management plan in the earliest possible time. Call Auckland 09 6311948 for or click on this link for an urgent appointment

Neck Lumps occur at different ages and in different areas of the neck and these factors can help lead to an early diagnosis. In younger adults and children lumps in the neck are usually either inflammatory or congenital in origin whereas in older adults a much higher index of suspicion for cancer must be maintained. The neck is divided into several regions: 1. Anterior neck; 2. Lateral neck; 3. Posterior neck; 4. Angle of the jaw; 5. Submandibular region. The anterior  neck is divided at the level of the hyoid bone into a. suprahyoid and b. infra hyoid regions. The lateral neck is further divided into a. The carotid sheath and b. The posterior triangle.

Posterior Neck Lumps

The posterior neck contains very few structures of importance and skin cancer metastasising to occipital and post auricular lymph nodes are the only significant malignancies that present in this region. Other lumps include lipomas and benign lymph node swellings.

Anterior Neck Lumps

Infrahyoid masses will be mostly thyroid in origin see Thyroid Surgery. Nearly all thyroglossal duct cysts are below the hyoid, slightly left of midline, and seen in young people. Pretracheal nodes that are caused by metastatic laryngeal or thyroid tumours can also present in this region . Suprahyoid masses may be thyroglossal but are more likely to be submental lymph nodes involved by inflammation or malignancy from the skin or oral cavity, particularly the floor of mouth. Dermoids are rare developmental inclusion cysts that form in the midline during embryonic development but often do not manifest until later in life. Thyroid tissue can arrest anywhere along the thyroglossal tract and can present in the submental region.

Lateral Neck Lumps

Lateral neck masses are more complex. They most commonly present in the carotid sheath in association with the carotid artery or jugular vein but they can also appear in the posterior triangle.
Solid lesions in the lateral neck are either nodal (inflammatory or metastatic malignancy) or they are rare tumours like carotid body tumours, neurogenic tumours associated with many of the nerves in the neck or rarely they can be malignant sarcomas of the deep neck tissues. Cystic lesions may be congenital branchial cleft cysts or lymphatic/vascular malformations. However they may also be cystic malignant nodes. These are notoriously difficult to diagnose and needle biopsies are often non- diagnostic.
Cystic nodal metastases are frequently confused with benign branchial cleft cysts and a careful history of upper aerodigestive tract symptoms is important to elicit.particularly in the era of HPV related Oropharyngeal cancer. Thyroid cancers may also appear as cystic lymph nodes in the lateral neck
Lesions in the skin and subcutaneous tissues are usually benign but skin cancers and melanoma can occur as cutaneous nodules.
Nodal lesions in the posterior triangle and supraclavicular area are less common. Metastases to this area either come from skin lesions in the posterior scalp or  from nasopharyngeal carcinoma, most frequently seen in Asian patients. Typically TB can affect lymph nodes in this area. Atypical TB in children tends to affect level I nodes in the submandibular area.

Submandibular Neck Lumps

Lumps in the submandibular area are usually related to the submandibular gland. Obstruction of the duct by stones or sludge typically presents as painful swelling associated with eating or even with the thought of food. The swelling will generally resolve over a period unless an ascending infection develops. Sometimes the stone can be felt in the duct in the floor of the mouth. Massaging the gland rather than producing a good flow of clear saliva often produces a small amount of turbid saliva or none at all. Submandibular salivary tumours present as painless progressive swellings. About 50% are malignant. See Salivary Gland Surgery.

Lymph node metastases to this area are either from lip or anterior facial skin cancers or from tumours on the oral tongue, floor of mouth or buccal mucosa.

Lumps at the Angle of the Jaw

Parotid swellings, that occur in the preauricular area, in the tail (which is often difficult to separate from the upper neck) or in the deep lobe, are usually neoplasms. Most tumours are benign but NZ has a high incidence of metastatic skin cancer to nodes in the parotid and our most common parotid malignancy is metastatic SCC. See Salivary Gland Surgery
Congenital cysts can occur in this region and they originate from the first branchial arch.

 

If you have concern regarding a neck lump call our One Stop Neck Lump Clinic on Auckland 09 6311948