A lump on the back of the neck can be a surprising discovery, often prompting concern. While many are not serious, this article provides general information about common causes and when medical evaluation is suggested. It is not a substitute for professional medical consultation.
Common Causes of Lumps on the Back of the Neck
One frequent reason for a lump in this area is swollen lymph nodes. These small, bean-shaped structures are part of the immune system, filtering harmful substances and fighting infections. When the body is combating an infection, such as a cold, flu, ear infection, or strep throat, lymph nodes in the neck can enlarge as they work to clear the infection. Swollen lymph nodes often feel soft and tender, and they may be painful.
Another common type of lump is a lipoma, a benign fatty tissue growth just beneath the skin. Lipomas are typically soft, round or oval-shaped, and movable when pressed, often not causing pain unless they press on nerves. They grow slowly and can vary in size, from small to larger masses. The neck is a common location for lipomas.
Cysts can also appear on the back of the neck as sacs filled with fluid or semi-solid material. Sebaceous cysts, for instance, arise from blocked or damaged sebaceous glands, which produce oil for the skin and hair. These cysts usually feel like small, soft bumps. Acne, including deep cystic acne, can also lead to lumps and swelling on the back of the neck, especially near the hairline, due to blocked pores, sweat, bacteria, and oil.
Muscle knots are tight bands of muscle tissue in the neck. These can result from muscle injury, overuse, stress, or poor posture, and are often painful and sensitive. Activities like prolonged phone use or computer work can strain neck muscles, leading to these knots. Some lumps can indicate more serious conditions like infections such as abscesses (pus-filled pockets) or cancerous growths like lymphoma or metastatic cancer. Lymphoma presents as a painless swelling of lymph nodes that does not go away.
When to Consult a Doctor
Certain characteristics and accompanying symptoms warrant medical evaluation. Consult a healthcare provider if a lump appears suddenly or grows rapidly. Pain, tenderness, or redness accompanying the lump also warrant medical review.
Lumps that feel hard, fixed, or immovable should be examined by a doctor. Any lump that persists for more than a few weeks without improvement, especially if it does not subside after an infection clears, requires examination. Other concerning symptoms include unexplained weight loss, fever, night sweats, or persistent fatigue.
Difficulty swallowing, hoarseness, or trouble breathing in conjunction with a neck lump are significant symptoms requiring prompt medical attention. Any lump that causes personal concern or anxiety, regardless of other symptoms, should also be discussed with a healthcare provider.
How Lumps Are Diagnosed
Diagnosing the cause of a neck lump begins with a physical examination and medical history. During the physical exam, a healthcare provider will feel the lump to assess its size, texture, mobility, and tenderness. They will also examine the surrounding areas, including the scalp, ears, eyes, nose, mouth, and throat. Discussing recent illnesses and overall health helps the doctor understand the context of the lump.
Diagnostic tests may be ordered to determine the cause. Blood tests, such as a complete blood count (CBC), can check for signs of infection or inflammation, indicated by elevated white blood cell counts. Imaging scans provide detailed views of the lump’s internal structure and its relationship to surrounding tissues. An ultrasound of the neck uses sound waves to evaluate the lump non-invasively, often preferred for children to avoid radiation. Magnetic resonance imaging (MRI) and computed tomography (CT) scans offer more detailed images of the head and neck structures.
If diagnosis is unclear or a serious condition is suspected, a biopsy may be performed. Fine needle aspiration (FNA) is a common procedure using a small needle to collect cells for laboratory analysis. It is often done in the office, sometimes with ultrasound guidance for accuracy. A core biopsy (using a slightly larger needle) or an open biopsy (removing part or all of the lump) might be necessary for a more comprehensive analysis.
General Treatment Considerations
The treatment for a neck lump depends on its underlying cause. For many benign lumps, such as small, asymptomatic lipomas or cysts, observation may be the primary approach. If the lump is a swollen lymph node due to an infection, it typically resolves once the infection clears.
Medications are prescribed for infection or inflammation. Bacterial infections are treated with antibiotics. Anti-inflammatory drugs reduce swelling and discomfort from inflammatory conditions or muscle knots. Muscle knots can also benefit from physical therapy, stretching exercises, massage, and heat or ice.
For abscesses or certain cysts, drainage may be necessary to remove fluid or pus. Surgical removal is an option for larger, symptomatic, or suspicious lumps. It is common for bothersome lipomas or recurrent/infected cysts. If a serious cause like cancer is identified, treatment involves surgical removal, radiation, or chemotherapy, depending on the type and stage. Patients are referred to specialists (e.g., oncologist, ENT) for comprehensive management.