Summary

Persistent unexplained cervical lymphadenopathy: in an adult, investigate promptly for malignancy. ^{Adult neck mass}
Sampling: ultrasound-guided FNA or core biopsy for a suspected metastatic node; excision or core biopsy for suspected lymphoma, which needs tissue architecture. Plan infection testing and tissue handling before the sample is taken. ^{NICE NG52} ^{RCPath G062}

1. Triage and history

Emergency features: stridor/stertor, drooling, respiratory distress, rapidly progressive swelling, severe trismus/torticollis, toxicity or haemodynamic instability. Secure the airway before imaging: controlled intubation with anaesthesia, with a senior surgeon prepared for tracheostomy if difficult access or a surgical airway is anticipated. ^BSAC
Duration and behaviour: onset, fluctuation, growth, pain, overlying skin changes, prior episodes and response to any treatment. In adults, a noninfective mass present for ≥2 weeks, or of uncertain duration, is suspicious for malignancy. ^{Adult neck mass}
Primary-site symptoms: dysphagia, odynophagia, persistent sore throat, referred otalgia, dysphonia, oral ulceration, unilateral nasal symptoms and cranial neuropathy. Ask about skin, dental, thyroid and salivary symptoms.
Systemic/exposure context: fever, rigors, drenching sweats, weight loss, pruritus, fatigue, other lumps, immune suppression/HIV risk, TB contact, travel, cat exposure and raw dairy exposure. Take a medication and previous malignancy/radiotherapy history.
B symptoms: unexplained fever, drenching sweats and >10% weight loss over 6 months. Their absence does not exclude lymphoma. ^Lugano
Children: recent URTI, scalp/skin disease and dental infection are the usual contexts. ^{NICE NG12}