7
Diagnosis
Avoidance Of Antibiotic Therapy
Î Clinicians should NOT routinely prescribe antibiotic therapy for
patients with a neck mass unless there are signs and symptoms of
bacterial infection. (R-C)
Standalone Suspicious History
Î Clinicians should identify patients with a neck mass who are at
increased risk for malignancy when the patient lacks a history of
infectious etiology and the mass has been present for ≥2 weeks
without significant fluctuation, or the mass is of uncertain duration.
(R-C)
Standalone Suspicious Physical Examination
Î Clinicians should identify patients with a neck mass who are at
increased risk for malignancy based on one or more of these physical
examination characteristics: fixation to adjacent tissues, firm
consistency, size >1.5 cm, and/or ulceration of overlying skin. (R-C)
Additional Suspicious Signs and Symptoms
Î Clinicians should conduct an initial history and physical examination
for all adults with a neck mass to identify those patients with an
increased risk for malignancy. (R-C)
Follow Up of Patient Not At Increased Risk
Î For patients with a neck mass who are not at increased risk for
malignancy, clinicians or their designees should advise patients of
criteria that would trigger the need for additional evaluation. Clinicians
or their designees should also document a plan for follow up to assess
resolution or final diagnosis. (R-C)
Patient Education
Î For patients with a neck mass who are deemed at increased risk
for malignancy, clinicians or their designees should explain to the
patient the significance of being at increased risk, and explain any
recommended diagnostic tests. (R-C)
Targeted Physical Examination
Î Clinicians should perform, or refer the patient to a clinician who can
perform, a targeted physical examination (including visualizing the
mucosa of the larynx, base of tongue, and pharynx), for patients with a
neck mass deemed at increased risk for malignancy. (R-C)
