How can I differentiate between benign and malignant lesions in the head and neck region during a physical examination?

During a physical examination in the head and neck region, differentiating between benign and malignant lesions involves assessing several key characteristics and associated symptoms.

• Consistency and Mobility: Malignant lesions, particularly neck lumps, are often described as hard and fixed, meaning they do not move freely under the skin ¹. In contrast, benign lumps are typically softer, more mobile, and may be tender to the touch, often indicating an an inflammatory or infectious cause ¹.
• Growth Pattern: A rapidly enlarging lesion is a concerning feature suggestive of malignancy ¹.
• Location: Lumps located in the supraclavicular region are more likely to be malignant ¹.
• Associated Symptoms: Several persistent, unexplained symptoms warrant suspicion of malignancy and require urgent referral ²,⁴. These include unexplained hoarseness lasting more than 3 weeks ², unexplained oral ulceration or a mass persisting for over 3 weeks ², and persistent unexplained red or white patches (erythroplakia or leukoplakia) in the oral cavity ². Other concerning symptoms are dysphagia (difficulty swallowing), odynophagia (painful swallowing), or a globus sensation (feeling of a lump in the throat) ². Unilateral serous otitis media in adults, a persistent sore throat (especially unilateral) with earache, unexplained trismus (difficulty opening the mouth), and unexplained cranial neuropathy are also red flags ². Unexplained cervical lymphadenopathy should also raise suspicion ². Systemic symptoms such as unexplained weight loss can also indicate malignancy ¹.
• Patient Factors: For new neck lumps, age is a significant factor, with those appearing in people over 40 years being more likely to be malignant ¹.

An organized approach to diagnosis, considering all these factors, is crucial for both benign and malignant lesions, including those in children and adolescents (Yuhan et al., 2018).