THE PROBLEM of a mass in the neck confronts the head and neck surgeon so frequently that he automatically searches the upper respiratory tract for a primary neoplasm even before giving his attention to the lesion which is the patient's immediate concern. If the node has already been biopsied through a surgical incision (as far too often happens), he is prone to condemn the individual who has failed first to look for a primary before entering the neck. In most instances one can find the source of the metastasis with little difficulty.
However, in a small percentage of cases no primary lesion can be found, even by careful repeated examination. This incidence ranges from 3%1 to 9%2 in studies of metastatic cervical lymph node cancer. Excluded, of course, are diseases of the lymphoma series which may involve these nodes.
Lacking a detectable primary—and one must assume that these
KEIM WF. The Occult Primary in Head and Neck Surgery. Arch Otolaryngol. 1966;84(5):566–569. doi:10.1001/archotol.1966.00760030568020
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