The most common manifestation of a pediatric head and neck malignancy is an asymptomatic neck mass. Fifty percent of all primary infantile malignancies originate in head and neck and twenty-five percent of all pediatric malignancies eventually involve the head and neck. As a result, any high degree of suspicion for a presenting neck mass should warrant a biopsy to ensure prompt diagnosis. Potential clinical indicators for malignancy include rapid growth in the absence of inflammation, fixation to underlying structures, skin ulceration, or size > 3 cm. Common pediatric malignancies presenting in the neck are thyroid cancer, rhabdomyosarcoma, and Hodgkin’s and non-Hodgkin’s lymphoma. All can be fully treated with early detection.

Pediatric neck masses are a common reason for a child to visit the pediatrician. Categorizing the lesions into congenital, inflammatory, or potentially neoplastic while focusing on location in the neck, with judicious use of imaging can help generate a differential to aid in diagnosis. Definitive management of these lesions can then ultimately be achieved by working closely with an otolaryngologist.