9
Table 3. Characteristics Suspicious for Malignancy in the
Presence of a Neck Mass
Standalone characteristics suspicious for malignancy
Characteristic Rationale
1. Absence of
infectious etiolog y
Absence of recent infection makes infection an unlikely
etiolog y for the neck mass.
2. Mass present
≥2 weeks or of
uncertain duration
A persistent mass is more likely to be malignant.
3. Reduced mobility of
neck mass
Metastatic cancer may violate the lymph node capsule and
directly invade adjacent structures.
4. Firm texture of mass
A malignant lymph node is oen firm due to the absence of
tissue edema.
A neck mass may be so due to its fluid content, and, while
this sometimes is due to a benign cystic mass, fluid-filled cystic
masses may also be malignant.
An infectious lymph node may be so due to tissue edema.
5. Neck mass size
>1.5 cm
Lymph node metastases results in nodal enlargement.
6. Ulceration of skin
overlying the neck
mass
Metastatic cancer may break through the capsule of the lymph
node and directly invade and necrose the skin.
Alternatively, the ulceration overlying a neck mass may indicate
a cutaneous malignancy with direct extension into the neck.
Additional characteristics of history and physical examination suspicious for
malignancy
1. Age >40 years
Older age is associated with greater risk of HNSCC–
particularly in patients with non-HPV related disease.
2. Tobacco and
alcohol use
Tobacco and alcohol are synergistic risk factors for HNSCC.
3. Pharyngitis
"Sore throat" or throat pain may indicate mucosal ulceration
or mass.
4. Dysphagia
Difficult swallowing may indicate ulceration, mass, or
dysfunction of the aerodigestive system.
5. Otalgia ipsilateral
to the neck mass
Otalgia, with normal ear exam, may represent referred pain
from the pharynx.
Unilateral serous otitis media may result from Eustachian tube
obstruction by a nasopharyngeal malignancy.
