02_35 Skin, Head and Neck: Lumps

Skin, Head and Neck Lumps
Session Overview
Description
This session provides an overview of the approach to patients presenting with common head and neck lumps. It describes the common pathologies of benign/malignant and congenital/acquired neck swellings and provides an overview of a safe clinical approach to investigation.

Learning Objectives
By the end of this session you will be able to:

• Characterise the common neck swellings in the head and neck and describe by anatomical site (including being able to classify the lymphatic levels of the neck according to the Memorial Sloan Kettering (MSK) classification)
• Recognise common clinical neck swellings, including salivary glands and be able to offer a differential diagnosis
• Discuss features of common congenital neck lumps occurring in adults and children
• Distinguish between benign and malignant lesions of the skin, head and neck
• Demonstrate a rational approach to the investigation of a neck lump

Prerequisites
Before commencing this session you should have:

• Basic knowledge of salivary and thyroid gland pathology
• Familiarity with examination of the neck
• Basic knowledge of the key benefits of, and differences between, ultrasound, computed tomography and magnetic resonance imaging

Head and neck swellings are common presentations to the ENT/Head and Neck Surgeon, and may also present to the general surgeon, acute medical clinicians and general practitioners.

In adults, particularly those over 35 years of age, the approach to the investigation should prioritise excluding an underlying malignancy.

Clinical examination and description of the swelling, and its relationship to the overlying skin, deeper structures and potential involvement of adjacent tissues, including neurovascular structures, will guide the differential diagnosis.

Investigation of a neck swelling in the adult will be guided by its location in the neck, and suspected origin. Complete examination may be indicated by nasendoscopy examination of the mucosa of the laryngopharynx. The session will provide a step-by-step approach to the initial assessment, investigation and management of common neck swellings.