Approach to a Neck Lump

Key points

• • Midline: thyroid (moves on swallowing) or thyroglossal cyst (moves on tongue protrusion).
• • Lateral: lymph nodes (commonest), branchial cyst, carotid body tumour or salivary gland.
• • In adults over 40 a persistent lump may be metastatic squamous cancer - examine the mouth and throat and refer to ENT.
• • Reactive nodes are common in children; persistent, hard or fixed nodes need investigation.