6
Key Points
Î Infections cause most of the neck masses in children. Most persistent
neck masses in adults are neoplasms, such as squamous cell
carcinoma (HNSCC), lymphoma, thyroid or salivary gland cancer.
Î A neck mass in the adult patient should be considered malignant until
proven otherwise.
Î Timely diagnosis of a neck mass due to metastatic HNSCC is
paramount because delayed diagnosis directly impacts tumor stage
and worsens prognosis.
Î Recent decreases in HNSCC due to reduced tobacco use have been
offset by an increasing prevalence of HPV infection—225% from 1988
to 2004.
• Patients with HPV-positive HNSCC are younger, mostly male, have more oral
and vaginal sexual partners, better dentition, less or no tobacco exposure, less
alcohol consumption, greater marijuana use, higher education level and higher
socioeconomic status. This demographic is no longer at low risk.
Î Among patients with HNSCC who present with neck mass, diagnostic
delays of 3–6 months are common, which is particularly disappointing
since delays as short as 2 months are associated with worse functional
outcomes, lower quality of life, cancer recurrence and death.
Î Fine needle aspiration (FNA), rather than open biopsy, is the preferred
method for cancer diagnosis in a neck mass.
