Neck Lumps: When to Seek Medical Attention

Cervical lymphadenopathy

Hello doctor, I have a lump located at the junction of my chin and neck, and the situation is as follows: 1.
Duration: It has been over 1.5 years.
2.
Size and texture: 1 to 1.5 cm, smooth, elastic, and movable.
3.
Medical history: (1) In the past, whenever I had acne on my face, I would experience lymphadenitis in the area just in front of my chin, but it would resolve within 1 to 3 months.
Initially, I thought this lump would also go away, but after more than six months, I consulted a surgeon who said it would disappear on its own; after one year, he still said the same thing, and only performed a physical examination.
(2) I have chronic skin inflammation around my face, nose, chin, and glabella, and I need to apply a topical cream daily; otherwise, the dermatitis flares up.
I have seen many dermatologists, but they only prescribe steroids, and the symptoms have persisted for two years.
4.
Lifestyle: I have long-term insomnia, high work stress, and nighttime anxiety.
5.
Symptoms: (1) Itchy skin on my neck for about three weeks.
(2) A lump about 1 cm in size in the groin area of my inner thigh for 8 to 10 months.
(3) I used to experience occasional sharp pains, but in the past six months, the pain has become more widespread and frequent (several times a day, with increasing duration), getting closer to the angle of my jaw and extending down my neck.
(4) Recently, I have had a constant feeling of swelling at the base of my tongue, but no sensation of a foreign body when swallowing.
(5) In the past week, I have felt something constricting around my throat.
(6) Tightness in the skin of my neck.
What should I do, doctor? I am very anxious and can't sleep because it is inconvenient to seek medical care living on an outer island.
I can only see an ENT specialist once a month, and the surgeons at our hospital are quite casual.
A chest X-ray during a health check showed a suspected shadow, but they didn't take a new film and only referred to the old one, saying it was nothing to worry about.
Which specialist should I see? (Crying)

hen dan xin, 30~39 year old female. Ask Date: 2020/09/19

Dr. Chen Sirong reply Oncology

Hello, because I am an oncologist, I can only answer questions related to tumors.

1.
There is a lump in the middle of the junction between the chin and neck, and the situation is as follows: A: It has been over 1.5 years.
The lump is smooth, elastic, and movable.
It does not appear malignant.
If it were malignant, it should have continued to grow.
2.
There is a lump about 1 cm in size in the inner thigh groin area for approximately 8 to 10 months.
A: It has been 1 year.
It does not appear malignant.
If it were malignant, it should have continued to grow.
3.
Which specialty should I see? A: Both ENT specialists and surgeons share my opinion that as long as you continue to monitor it, that is sufficient.
You might think that (the surgeon is being too casual).
In terms of tumors, ongoing surgical follow-up is adequate.
For physical discomfort, I recommend seeing a traditional Chinese medicine practitioner for body conditioning.

Lifestyle: Long-term late nights, high work stress, and nighttime anxiety.
Adjustments for mental and physical well-being rely on yourself or a psychiatrist, depending on your decision.
Wishing you health and well-being.

Taoyuan Hospital, Chen Sih-Rong.

Reply Date: 2020/09/19

More Info

Hello, thank you for sharing your concerns regarding the lump in your neck and the associated symptoms. Based on the details you've provided, it seems that you are experiencing a range of issues that warrant further evaluation. Here’s a breakdown of your situation and some recommendations on how to proceed.

Understanding Your Symptoms
1. Duration and Characteristics of the Lump: The lump you described has been present for over 1.5 years, measuring about 1-1.5 cm, and is movable and elastic. While some lymph nodes can remain enlarged for extended periods, especially after infections, a persistent lump that does not resolve over such a long time should be evaluated further.
2. Associated Symptoms: You mentioned several concerning symptoms, including:
- Itching in the neck area.

- Multiple lumps in the groin area.

- Increasing pain and discomfort radiating from the original lump.

- A sensation of swelling at the base of your tongue.

- A feeling of tightness in the neck.

These symptoms, particularly the pain radiating from the lump and the new sensations in your throat, could indicate that the condition is changing and may require more urgent attention.

3. Medical History: Your history of skin inflammation and the treatments you've received suggest that you may have underlying issues that could be contributing to your current symptoms. Chronic skin conditions can sometimes be linked to systemic issues, and the presence of multiple lumps could indicate a more widespread condition.

When to Seek Medical Attention
Given the persistence of the lump, the changes in your symptoms, and the increasing pain, it is advisable to seek medical attention sooner rather than later. Here are some steps you can take:
1. Consult an Ear, Nose, and Throat (ENT) Specialist: Since you have already been seeing an ENT, it would be beneficial to return for a follow-up. Explain your new symptoms in detail, especially the pain and the sensation of tightness in your throat. An ENT can perform a thorough examination and may recommend imaging studies, such as an ultrasound or CT scan, to assess the lump and surrounding tissues.

2. Consider a General Surgeon: If your ENT is unable to provide a satisfactory evaluation or if you feel your concerns are not being taken seriously, consider seeking a second opinion from a general surgeon. They can perform a physical examination and may recommend a biopsy of the lump to rule out any serious conditions.

3. Addressing Anxiety and Stress: Your anxiety about the situation is understandable, especially given the challenges of accessing healthcare on an outer island. It may be helpful to speak with a mental health professional who can provide strategies to manage your anxiety while you navigate your health concerns.

4. Document Your Symptoms: Keep a detailed record of your symptoms, including when they occur, their severity, and any changes over time. This information can be invaluable during your medical consultations.

Conclusion
In summary, while the lump you have may not be immediately alarming, the persistence of symptoms and the recent changes suggest that further evaluation is necessary. Do not hesitate to advocate for your health; if you feel your concerns are not being addressed, seek a second opinion. Your well-being is paramount, and it is important to ensure that any potential issues are thoroughly investigated. Please take care, and I hope you find the answers and relief you need soon.

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