Symposium. ENT for nonspecialists. The patient has a lump in the neck

When a patient presents with a hard, painless lump in the neck, one should assume that it is a cancer and that it is metastatic from a primary lesion located above the clavicle. A careful physical examination with the appropriate instruments most often will determine the site of the primary lesion. Laryngograms or lateral soft-tissue roentgenograms should not be used as a substitute for visual inspection and careful examination. Examination with the patient under anesthesia is not needed unless the office examination cannot be done or a specimen from the suspected region cannot be obtained and examined microscopically in the office. Taking blind biopsies from normal-appearing mucosa is seldom worthwhile. Excisional biopsy is usually done with the patient under general anesthesia; needle biopsy is seldom used. Pathologic diagnosis by examination of frozen section is mandatory. Definitive treatment depends on the surgical and pathologic findings.