Neck Lumps in Children: Benign vs. Malignant Concerns

My five-year-old son has a hard lump/tumor under his left ear, approximately two centimeters in diameter?

Hello Doctor, my five-year-old son has a hard lump/tumor located about five centimeters below his left ear on the neck.
This lump, which is less than two centimeters in diameter, was first noticed when he was less than a year old.
At that time, the lump's diameter was less than 0.5 centimeters.
However, this year, at the age of five, I have observed that the lump has grown significantly, with a diameter of approximately 1.0 to 1.5 centimeters.
When I palpate the lump, it is painless, soft, and can be moved about one to two centimeters side to side.
Based on the symptoms described, do you think this lump/tumor is more likely to be benign or malignant? If it is benign, is there a possibility that it will continue to grow? Additionally, could its location on the neck, below the left ear, affect his health and growth? Is surgical removal necessary? Thank you, Victoria.

Jingyi, 30~39 year old female. Ask Date: 2016/06/20

Dr. Chen Sirong reply Oncology

1.
Is this lump/tumor more likely to be benign or malignant?
A: It is mostly benign.

2.
If it is benign, can it still continue to grow?
A: Yes, it can.
Isn't it already continuing to grow?
3.
Will the location in the neck, below the left ear, affect health and the growth of the child? Is removal necessary?
A: If the patient feels uncomfortable, it can be removed.
If you are worried about leaving it as is, then it can also be removed.
If you choose not to remove it, any changes such as growth, color change, or hardness should prompt a visit to the doctor.
Since it has already grown, it is advisable to seek medical evaluation.
Online consultations cannot definitively rule out malignancy.
Thank you for your inquiry.

Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2016/06/20

More Info

Hello Victoria,
Thank you for reaching out with your concerns regarding your son's neck lump. It's understandable to be worried about any growth in a child's body, especially when it has changed in size over time. Based on your description, let’s break down the characteristics of the lump and discuss the potential implications.

From what you’ve described, the lump is located about five centimeters below the left ear, has been present since your son was less than a year old, and has grown from approximately 0.5 cm to 1.0-1.5 cm in diameter. It is non-painful, soft, and mobile. These characteristics are often associated with benign conditions, but it’s essential to consider a few factors to better understand the situation.

Benign vs. Malignant Concerns
1. Benign Conditions: The lump could be a benign lymph node, which is common in children. Lymph nodes can enlarge due to infections, inflammation, or other non-cancerous conditions. Other possibilities include cysts, such as a branchial cleft cyst, or lipomas, which are fatty tumors that are also typically harmless.

2. Malignant Concerns: While the characteristics you mentioned lean towards a benign nature, it is crucial to rule out malignant conditions, especially if there is a significant change in size or if the lump becomes hard, fixed, or painful. Malignant tumors in children, although rare, can occur and may present as a firm, immobile mass.

Growth and Impact on Health
Regarding your question about whether a benign lump can continue to grow, the answer is yes. Benign tumors can grow over time, but they usually do not pose a significant risk to health unless they compress nearby structures or cause discomfort. In the case of a lump located near the neck and ear, it could potentially affect nearby nerves or blood vessels if it grows large enough, but this is not common.

Need for Surgical Intervention
As for whether surgical removal is necessary, this decision typically depends on several factors:
- Size and Growth: If the lump continues to grow or changes in character (becomes hard, painful, or fixed), a healthcare provider may recommend removal for further evaluation.

- Symptoms: If your son experiences any symptoms such as difficulty swallowing, breathing issues, or persistent pain, these would warrant further investigation.

- Diagnosis: Often, imaging studies (like an ultrasound or MRI) and possibly a biopsy are recommended to determine the nature of the lump before deciding on surgery.

Recommendations
1. Consult a Specialist: I recommend that you take your son to a pediatrician or an ear, nose, and throat (ENT) specialist for a thorough examination. They may suggest imaging studies to assess the lump further.

2. Monitoring: If the lump is determined to be benign and not causing any symptoms, your healthcare provider may suggest a watchful waiting approach, with regular follow-ups to monitor its size and characteristics.

3. Educate Yourself: Understanding the nature of the lump and the potential implications can help alleviate some of your concerns. Ask your doctor any questions you may have during your visit.

In conclusion, while the characteristics of the lump suggest it may be benign, it is essential to have it evaluated by a healthcare professional to ensure proper diagnosis and management. Early intervention can provide peace of mind and address any potential issues before they become significant concerns.

Best wishes to you and your son for a healthy outcome.

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