1. Skin infections/abscesses

Types of neck lumps:
1. Skin infections/abscesses

2. Lymphadenopathy:

– Benign reactive lymph nodes (common in children)
– Characteristics: Small, multiple, bilateral, tender, mobile
– Timing: Present within first few days of infection, subside after a couple of weeks
– Distribution: Localised (e.g., URTI) or generalised (e.g., infectious: EBV, HIV, HSV,
cytomegalovirus & non-infectious: CT disorders, sarcoidosis, amyloidosis).
– Treatment: Antibiotics for bacterial infections
– Follow-up: Consider two-week wait referral if persistent after 2-4 weeks

c) Malignant causes:

– Leukaemia

• • Features of Leukaemia with generalised Lymphadenopathy +/- splenomegaly

– Lymphoma

• • Hepatosplenomegaly, B cell symptoms (fever, fatigue, weight loss, night sweats),
  • LN: initially painless & rubbery + soft & mobile, often located in the posterior
    triangle and rapidly growing with eventual generalisation

– Lymph node metastasis

• Upper and middle neck: Head and neck tumours
• Lateral neck: Squamous cell carcinoma of mouth or upper oesophageal cancers
• Lower neck (Supraclavicular lymph nodes):
  o Above clavicle: Thyroid or oesophageal
  o Below clavicle: Breast or genital tumours
  o *Enlarged LN in the left supraclavicular fossa indicates a metastatic malignancy
  from a primary tumour below the clavicle = Virchow’s node

3. Benign tumours (common in children and young adults):
– Lipoma (mid-adulthood, painless/soft/mobile/discrete/, can occur anywhere on the body)
– Chondroma (multi-hard nodules in the larynx)
– Neuromas (can be isolated or part of a syndrome, e.g., schwannoma, associated with NF
type 1 linked to café-au-lait-spots)
– Infantile haemangiomas (present shortly after birth)

4. Malignant primary tumours
– Mainly from squamous cell cancer of the upper respiratory and GI tracts
– More common in those over 40-45 years

5. Thyroid lumps
– Move upwards while swallowing
– Assess for thyroid symptoms and complications associated with airway obstruction
– Most are benign

6. Salivary gland tumours

• Tumours:
  o Usually in older people, mainly involving the parotid gland & benign solitary
  neck muscle well defined and painless. Also, it is slow-growing and mobile.
  o Rarely malignant tumours can develop, but these develop in the
  submandibular region & these can present as solitary neck masses that are
  painful and rapidly growing with skin fixation and possible facial nerve
  involvement if the parotid gland is involved.
• Calculi (sialolithiasis):
  o Mainly in submandibular gland
  o Increased swelling and pain when eating due to increased saliva production
  o Symptoms only last for a few minutes. If prolonged, then suspect secondary
  infection (sialadenitis). Persistent inflammation can eventually develop into a
  permanently swollen gland ( chronic obstructive sialadenitis).
• Sialadenitis
  o Bacterial (Staph aureus) or viral (mumps, HIV) infection
  o Mainly of the parotid gland
  o Pain, redness, swelling & oedema