I found this small lump on the left side of my neck. It is located a little higher than my collar bone. I first noticed it about two months ago, then forgot about it. I remembered it again about two weeks ago, checked it and it is still there. There was no pain until recently. Now there is a warm sensation in that area. It is not painful but my neck is a little more stiff. Is there any reason for concern?

Patty

Mystery lumps are almost always a cause for concern. The only time I am comfortable ignoring a lump is if it has been present, unchanged, for several years. Even then, I worry that the patient may be in denial and may be distorting his/her history to downplay the seriousness of the condition.

The concern, of course, is that the lump may be a symptom of cancer. Cancers within the head and neck tend to spread first to the lymph nodes of the neck. Growth of the cancer within a lymph node leads to the development of a palpable neck lump. Also, the lymph nodes themselves may give rise to a cancer (lymphoma).

Unfortunately, there is no way for you to figure this one out on your own. I wish I could tell you, "If you've never smoked and don't drink much alcohol, you're in the clear," but this just isn't true. Lymphomas, for example, can afflict anyone. The only way to be certain of the diagnosis is to have a biopsy taken of the lump. This is usually done with a very slender needle (a procedure known as fine-needle aspiration biopsy).

Okay, now that I've scared the bejeebers out of you, let me give you the good news. Most of these lumps prove to be innocent. Even a trivial infection (the common cold, a sore throat, a pimple) can cause persistent enlargement of a single lymph node. Furthermore, this may not even be a lymph node! An experienced physician can often tell by examining the lump that it has arisen from the skin or subcutaneous tissues (tissues immediately below the surface of the skin). In such instances, the physician may decide that it is safe to forgo the needle biopsy and observe the lesion.

Observe means that you and your physician watch the lump carefully over the next few weeks. If it grows or changes in any other way, your physician may change his/her mind and decide that a biopsy is necessary. "Observe" does not mean "forget about it."

Your first task is to take this problem to your physician. Your doctor may feel comfortable managing this problem or may refer you to an ear, nose and throat specialist (ENT). If your doctor (or your ENT) thinks a biopsy is necessary, DO IT. Early diagnosis and treatment are still our primary defenses against cancer.