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 NICE CKS. In contrast, benign lumps are typically softer, more mobile, and may be tender to the touch, often indicating an an inflammatory or infectious cause NICE CKS.
• Growth Pattern: A rapidly enlarging lesion is a concerning feature suggestive of malignancy NICE CKS.
• Location: Lumps located in the supraclavicular region are more likely to be malignant NICE CKS.
• Associated Symptoms: Several persistent, unexplained symptoms warrant suspicion of malignancy and require urgent referral NICE NG12,NICE CKS. These include unexplained hoarseness lasting more than 3 weeks NICE NG12, unexplained oral ulceration or a mass persisting for over 3 weeks NICE NG12, and persistent unexplained red or white patches (erythroplakia or leukoplakia) in the oral cavity NICE NG12. Other concerning symptoms are dysphagia (difficulty swallowing), odynophagia (painful swallowing), or a globus sensation (feeling of a lump in the throat) NICE NG12. 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 NICE NG12. Unexplained cervical lymphadenopathy should also raise suspicion NICE NG12. Systemic symptoms such as unexplained weight loss can also indicate malignancy NICE CKS.
• 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 NICE CKS.

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.