What are the key clinical features to differentiate between benign and malignant neck lumps in adults?

Key clinical features used to differentiate between benign and malignant neck lumps in adults include:

• Age: Neck lumps in adults aged 45 and over are more suspicious for malignancy and warrant urgent referral for suspected cancer pathways ¹.
• Persistence and unexplained nature: Persistent and unexplained neck lumps should raise suspicion of malignancy and prompt urgent referral ¹.
• Size and growth: Lumps that are unexplained and increasing in size in adults are concerning for malignancy and require urgent investigation such as ultrasound within 2 weeks ¹.
• Location: Supraclavicular or persistent cervical lymphadenopathy in adults aged 40 and over is more likely to be malignant and requires urgent chest X-ray to exclude lung cancer ¹.
• Associated symptoms: Systemic symptoms such as fever, night sweats, weight loss, pruritus, shortness of breath, or alcohol-induced lymph node pain suggest lymphoma and warrant urgent referral ¹.
• Consistency and fixation: Although not explicitly detailed in the provided context, malignant lumps are often hard, fixed, and non-tender, whereas benign lumps tend to be soft, mobile, and painless ¹.

In summary, malignant neck lumps in adults are typically persistent, unexplained, increasing in size, located in high-risk areas (e.g., supraclavicular), associated with systemic symptoms, and occur in older adults (≥45 years), all of which should prompt urgent referral for suspected cancer pathways ¹.