Metastatic cancers to the neck from undetermined primary sites: long-term follow-up

When a patient presents with a mass in the neck, diagnosis by fine needle aspiration cytology is recommended. This allows an accurate diagnosis of malignancy with minimal morbidity. Tissue planes, important in any future definite neck surgery, are not altered, as they would be from an excisional biopsy. Once the diagnosis of metastatic cancer is confirmed, thorough search for the primary tumor must be made. The history, physical examination, and radiographic and laboratory studies must be complete. Finding no origin of tumor, local treatment of the metastases must be done, with the objective being complete eradication of disease. Regular follow-up, with a continual search for the primary malignancy is then recommended. The specifics of this approach and the results of our series are outlined.