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New Neck Mass Guideline Published

Melissa Pynnonen, MD, MSc, chair of the panel that developed the new clinical practice guideline, Evaluation of the Neck Mass in Adults, explains features of the guideline.

In recent years, the number of cases of HPV has skyrocketed. Because HPV is linked to some head and neck cancers, AAO-HNSF has developed a new clinical practice guideline to address an increasing number of patients who do not fit the traditional profile.

The new guideline, Evaluation of the Neck Mass in Adults, was published Sunday following a Miniseminar that reviewed its main points, including 10 key action statements.

“There are very few guidelines published on this topic, so there is a lack of information for healthcare providers,” said Melissa Pynnonen MD, MSc, chair of the panel that developed the guideline. “The impetus for this guideline is the need to identify those patients with a neck mass who potentially have a malignant mass.”

The profile of patients who developed squamous cell carcinoma of the mouth, throat, or tongue has changed in recent years. Previously, these patients were middle age or older and had a history of tobacco and alcohol use. However, a growing number of younger adult patients are being diagnosed with head and neck cancer and do not have a history of alcohol or tobacco use, she said.

“We want to help bring this to the attention of healthcare providers,” said Dr. Pynnonen, a professor of otolaryngology at the University of Michigan. “If they see a 25-year-old patient with a lump in their neck and the patient meets the risk criteria in the guideline, that patient should be appropriately evaluated to promote early identification of metastatic cancer.”

The guideline focuses on diagnosis of the neck mass. If cancer is diagnosed, the provider may refer to other guidelines or for specific recommendations for cancer treatment. Dr. Pynnonen identified some of the key elements of the new guideline.

  • If patients do not have signs or symptoms of bacterial infection, they should not be treated with antibiotics.
  • Standalone suspicious findings, such as a mass in the neck, place a patient at increased risk for malignancy. “If the lump has been there for two weeks or longer, or if the lump is firm, fixed, and greater than 1.5 cm, or if the skin over the lump is ulcerated, the provider should consider whether the patient may have cancer,” Dr. Pynnonen said.
  • Patient education materials integral to the guideline are part of the official document. A plain-language summary of the guideline is published as a separate article in Otolaryngology-Head and Neck Surgery.
  • A detailed patient history and physical exam are needed to identify the possible etiology of the neck mass.
  • CT with intravenous contrast is the preferred imaging modality for diagnosis.
  • A fine needle aspiration biopsy is preferred over open biopsy.

Forty years ago, patients with a neck mass experienced an average of a five- to six-month delay from the time of initial presentation to the diagnosis of malignancy. Today, studies continue to report delays as long as three to six months. The information in this guideline is targeted at anyone who may be the first clinician a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists.

The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes.

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