Pynnonnen et al identified features of a neck mass that may indicate a high risk of malignancy. A lesion with one of these "red flags" may benefit from more aggressive evaluation. The authors are from multiple institutions in the United States.

Patient selection: adult with a neck mass


Characteristics of a neck mass in an adult suspicious for malignancy:

(1) diameter > 1.5 cm

(2) absence of an infectious etiology

(3) mass present >= 2 weeks OR uncertain duration

(4) firm texture to the mass

(5) ulceration of overlying skin

(6) reduced mobility ("fixed")

(7) nontender mass



• A cystic lesion is often benign but a malignant tumor may appear to be cystic especially if there is central necrosis.

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