#LYMPH NODES BACK OF NECK SKIN#

Lymph node metastases to this area are either from lip or anterior facial skin cancers or from tumours on the oral tongue, floor of mouth or buccal mucosa. Submandibular salivary tumours present as painless progressive swellings. Massaging the gland rather than producing a good flow of clear saliva often produces a small amount of turgid saliva or none at all. Sometimes the stone can be felt in the duct in the floor of the mouth. The swelling will generally resolve over a period unless an ascending infection develops. Obstruction of the duct by stones or sludge typically presents as painful swelling associated with eating or even with the thought of food. Lumps in the submandibular area are usually related to the submandibular gland. Young woman with a large right primary submandibular gland tumour Atypical TB in children tends to affect level I nodes in the submandibular area. Typically TB can affect lymph nodes in this area. Metastases to this area either come from skin lesions in the posterior scalp or nasopharyngeal carcinoma. Nodal lesions in the posterior triangle and supra-clavicular area are uncommon. Lesions in the skin and subcutaneous tissues are usually benign but skin cancers and melanoma can occur as cutaneous nodules. These are notoriously difficult to diagnose and needle biopsies are usually non- diagnostic.Ĭystic nodal metastases are frequently confused with benign branchial cleft cysts and a careful history of upper aerodigestive tract symptoms is important to elicit. However they may also be cystic malignant nodes. Solid lesions in the lateral neck are either nodal (inflammatory or metastatic malignancy) or they are rare tumours like carotid body tumours, neurogenic tumours associated with many of the nerves in the neck or rarely they can be malignant sarcomas of the deep neck tissues.Ĭystic lesions may be congenital branchial cleft cysts or lymphatic/vascular malformations. They most commonly present in the carotid sheath in association with the carotid artery or jugular vein but they can also appear in the posterior triangle. Woman with a right level 2 nodal mass suggestive of a metastatic HPV related oropharyngeal cancer Thyroid tissue can arrest anywhere along the thyroglossal tract and can present in the submental region. Dermoids are rare developmental inclusion cysts that form in the midline during embryonic development but often do not manifest until later in life. Suprahyoid masses may be thyroglossal but are more likely to be submental lymph nodes involved by inflammation or malignancy from the skin of the lips, anterior facial skin or oral cavity, particularly the floor of mouth. Pretracheal nodes that are caused by metastatic laryngeal or thyroid tumours can also present in this region. Nearly all thyroglossal duct cysts are below the hyoid, slightly left of midline, and seen in young people. Infrahyoid masses will be mostly thyroid in origin see Thyroid Surgery. The middle ear will always be abnormal if the cause of the abscess is mastoiditis. An abscess can develop from a necrotic node or from mastoiditis with erosion of the mastoid bone. In the post auricular area lymph nodes can be enlarged by inflammation, lymphoma or metastatic skin tumours like melanoma or SCC from the posterior scalp. These types of masses can occur anywhere in the neck and for that matter on the body. The only masses that characteristically develop in the Back of the Neck are superficial masses like lipomas and sebaceous cysts and vascular or lymphatic malformations. Lateral either, carotid/ jugular or posterior triangle including the supra-clavicular region.Anterior or midline divided into supra and infra-hyoid.There are Six general regions in the neck where lumps characteristically appear In adults a persistent lump is likely to be neoplastic and malignancy must be excluded.

In Children and young adults inflammatory and congenital lumps are most common, One must always be aware that a lump may be a metastatic malignancy and that the first sign of the mass may be the primary site or vice versa. Other features that help differentiate a neck lump include: A neck lump that is hard, irregular, large, solid, fixed and non tender is likely to be malignant. Site ,size, edge, consistency, colour, attachment, transillumination, pulsation, tenderness, nodes. The features that help one diagnose neck lumps include: I have presented a systematic method of evaluating neck lumps to determine what they are most likely to be. Lumps in the neck are usually reactive neck lymph nodes or thyroid nodules but they can also, rarely, be cancer. Neck lumps are very common and they are mostly innocent. Neck Lumps Dr John Chaplin, Neck Lump Surgeon, Auckland NZ

Lymph nodes back of neck