Neck Lesions

• Thyroglossal duct cyst
• Branchial cleft cyst/sinus
• Enlarged lymph nodes

Dermoid Cyst

A “dermoid cyst” is a small mass or nodule under the skin that contains tissue or material made by the skin. They occur on the face, neck or scalp in most cases but can be present elsewhere on the body. When on the head, these cysts are usually adherent to a layer of the bone called the periosteum.

Dermoids are usually non tender and mobile under the skin. Because of the likelihood of enlargement over time, we recommend resection. The procedure is performed as an outpatient. If the cyst becomes infected, the patient is given antibiotics and the cyst is excised when the infection resolves.

There is a small risk of connection to the blood vessels under the skull for cysts that are in the midline so some may require special x-rays such as an MRI.

Skin Mole (Congenital Nevus)

These dark skin lesions are usually present from birth but can develop in the first two years of life. They are present in 1-2% on newborns. The lesions are one of several known risks factors for the possible development of a serious type of skin cancer called melanoma. The number of children under the age of nine with skin cancer is very, very low. In fact, the incidence is so low that biopsies read as ‘melanoma’ should always be read or re-read at a center that specialize in pediatric skin lesions. Skin cancer is rarely seen in the teenage years, but may occur.

Congenital nevi have been divided into 3 groups according to size. Small nevi are less than 1.5 cm in greatest diameter, medium nevi are 1.5-19.9 cm in greatest diameter, and large or giant nevi are greater than 20 cm in greatest diameter. Giant nevi may require more than one surgery for complete resection.

Removal of congenital nevi is performed either to improve the appearance of the patient or to reduce the likelihood of developing cancer in the lesion. If a patient has many lesions, removal is reserved for lesions that are changing.

Existing moles should be checked if there is a change in size, shape, color, or elevation (if it becomes raised). Pain, itching, ulceration, or bleeding of an existing mole should also be checked. A commonly used list of symptoms is referred to as the “ABCD guidelines”:

• Asymmetry – One side of the mole does not look like the other.
• Border irregularity – Margins may be notched or irregular.
• Color – Melanomas are often a mixture of black, tan, brown, blue, red, or white.
• Diameter – Cancerous lesions are usually larger than 6 mm across (about the size of a pencil eraser), but any change in size may be concerning.

All biopsied lesions are checked by a dermatopathologist and further treatment may be required if the lesions shows a skin cancer.

Branchial Cleft Cyst/Sinus
Branchial cleft cysts or sinuses are found in the neck and consist of a pocket created by a developmental error. They can change in size and shape and can enlarge when the patient has upper respiratory infections. Most are located in the front and can have an opening that drains mucus. They should be removed to prevent infection.

Lymph Node Enlargement

Lymph nodes are small pea-sized pieces of tissue under the skin that can become enlarged in reaction to an infection. These are usually harmless but sometimes require surgery if they become infected, enlarge in a pathologic manner, or are associated with other symptoms. Most enlarged lymph nodes are in the neck or armpits. As a general rule, cervical (neck area below the jaw) lymph nodes are biopsied if they continue to enlarge greater than 2cm in diameter for more than a few weeks. Lymph nodes that wax and wane in size may generally be watched for longer periods than those that continue to grow in size. Nodes the the supraclavicular area are more worrisome, and are often biopsied at a smaller size than cervical lymph nodes. It is common to have axillary lymph nodes less than 2cm in diameter which do not require biopsy in the absence of symptoms or infection. Biopsies of lymph nodes in children are always excisional biopsies rather than needle biopsy because the architecture of the node is essential for accurate diagnosis.