A neck mass that is malignant, or cancerous, is certainly dangerous and needs prompt medical attention. Malignant neck masses can arise from within a lymph node, known as a lymphoma. Malignant neck masses can also occur within other neck structures such as the salivary gland, thyroid, or soft tissue. Examples of these kinds of cancers include mucoepidermoid carcinoma, adenoid cystic carcinoma, papillary carcinoma and sarcomas. Malignant neck masses may also occur as a result of metastases, or spread from another part of the body. A common example of a metastatic malignant neck mass is squamous cell carcinoma that has spread from the upper aerodigestive tract.
Luckily, the majority of neck masses are benign. Even benign neck masses, however, often require surgical intervention because they have the potential to turn into cancer over time. An example of this are pleomorphic adenomas. Other benign neck masses include congenital malformations such as thyroglossal duct cysts or branchial cleft cysts. These cysts are often removed because they can become superinfected over time. These cysts also have a small possibility of harboring rare cancers. Benign thyroid neck masses may be removed if they are large enough to cause compressive symptoms such as difficulty swallowing or trouble breathing. Benign neck lipomas are also commonly removed because of cosmetic reasons. When neck masses become very large, they can cause significant musculoskeletal pain. Watch this large neck mass I surgically removed for this reason:
Another common cause of a neck mass is inflammation. Lymph nodes often temporarily become enlarged in response to viral or bacterial infections, especially upper respiratory tract infections. Autoimmune or rheumatologic conditions can also cause large inflammatory lymph nodes. Sometimes, a severe infection can lead to a neck abscess, which often requires surgical incision and drainage as well as aggressive antibiotics.
The good news is that the majority of neck masses are treatable. I employ a systematic stepwise approach in diagnosing and treating neck masses. The first step is often trying medical management if we believe there is an inflammatory component to the mass. The next step is usually imaging such as a CT scan followed by a possible ultrasound guided fine needle aspiration biopsy. If the neck mass is benign, I first consider treatment with medication, infectious disease or rheumatologic evaluations prior to surgery. If the neck mass is malignant, surgery is usually warranted along with medical oncology and radiation oncology consultations.
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