Young children often have lymph nodes in their upper neck and cause concern to the parents.  These may be caused from tonsillar infections.  Hallmarks of a benign (non-cancerous) process are that the mass is bilateral (both sides), soft, mobile and is not increasing in size.  Over 90% of children have lymph nodes in this area and not all can be biopsied.   However, if they become hard, fixed and multiple, biopsy to rule out a cancer may be necessary. 

In adults, neck masses are commonly caused by an infection, such as chronic tonsillitis or an infected tooth.  Other causes include congenital cysts (sacs of fluid) and cancers.  An exact diagnosis may be difficult without a biopsy. 

Masses in the posterior neck are often lymph nodes along the spinal accessory nerve.  Open biopsy in this area must be done with extreme caution because of risk to injuring this nerve and paralyzing the trapezius muscle.  This is a large muscle which raises the arm above the shoulder.

Masses in the lower neck are very worrisome, especially if just off midline.  A mass in this area may represent lymph nodes involved with cancer which has metastasis from the lungs or abdomen.  This is a common presentation of lung cancer. 

Masses are worrisome when they persist, are multiple, or are hard and fixed.  Because taking a large sample of tissue from the neck requires surgery, your doctor may decide to do a "needle biopsy".  A needle biopsy is performed by inserting a fine needle into the mass and using negative pressure to obtain a few cells for the pathologist to look at.  Unfortunately, this procedure is only about 95% accurate. 

An open biopsy, as shown below, is much more accurate, but it is difficult to do and may put various important structures at risk.

In the patient shown below, a needle biopsy indicated that the neck mass was from a congenital cyst.  However, upon exploration, infected lymph nodes were found.