4
Key Points
Figure 1. Key Action Statement (KAS) Algorithm
Adult with Neck Mass
END
Antibiotic
Therapy
KAS1
YES
Educate patient regarding significance of
being at increased rick for malignancy
Ancillary tests based
on history
and physical exam
KAS3
Perform targeted history and physical exam,
including pharynx, base of tongue, and larynx
KAS8
KAS4
YES
Manage
diagnosis
KAS5
NO
NO
Present ≥2 weeks or
uncertain duration?
Mass fixed, firm >1.5 cm,
or ulcerated?
Other suspicious findings*
on history & physical exam?
KAS2a
KAS2b
KAS2c
NO YES
Contrast enhanced CT
(or MRI) of the neck
Fine needle aspiration
instead of open biopsy
KAS6 KAS7
Diagnosis
obtained?
Document plan for
follow up
KAS9
One or
more suspicious
findings of
increased risk for
malignancy?
NO
Ancillary tests based on history
and physical exam
KAS9
If mass is cystic, continue evaluation
until a diagnosis is obtained and do
NOT assume it is non-malignant
Pan-endoscopy and
open biopsy
KAS10
YES
*Other Suspicious Findings:
• Age > 40 years
• Tobacco and alcohol use
• Pharyngitis or dysphagia
• Otalgia ipsilateral to
mass
• Oral or pharyngeal ulcer
• Recent voice change
• Recent ipsilateral
hearing loss, epistaxis,
or nasal obstruction
• Unexplained weight loss
• Prior head or neck
malignancy
• Non-tender neck mass
• Tonsillar asymmetry
• Skin lesions (face, neck,
scalp)
Resolution?
Signs and
symptoms
of bacterial
infection?
