What are the key clinical features that differentiate benign from mali

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Key clinical features differentiating benign from malignant lymphadenopathy in adults include:

Duration and progression: Benign lymphadenopathy often resolves within 2-4 weeks, especially if related to infection, whereas malignant lymphadenopathy tends to persist or progressively enlarge beyond this period .
Size and consistency: Malignant nodes are typically larger, firm or hard, and may be fixed to underlying tissues, while benign nodes are usually smaller, soft or rubbery, and mobile .
Location: Supraclavicular lymphadenopathy is more suspicious for malignancy, particularly lung or abdominal cancers, whereas benign causes are more common in cervical or axillary nodes .
Associated systemic symptoms: Features such as unexplained weight loss, night sweats, fever, pruritus, and splenomegaly suggest malignancy (e.g., lymphoma or leukemia) ,.
Laboratory findings: Unexplained anaemia, thrombocytopenia, or abnormal white cell differential may indicate haematological malignancy rather than benign reactive causes .
Response to treatment: Benign lymphadenopathy due to infection often improves with appropriate antibiotics or supportive care, whereas malignant nodes do not resolve and may worsen despite treatment .
Other red flags: Persistent unexplained hoarseness, oral ulceration lasting more than 3 weeks, or signs of a malignant primary tumour in the head and neck region warrant urgent referral .

What are the key clinical features that differentiate benign from malignant lymphadenopathy in adults?