From the Research
The evaluation and management of painless submental lymphadenopathy should begin with a thorough history and physical examination to identify potential causes, and if the lymph node is larger than 1 cm, persists beyond 4-6 weeks, or has concerning features, imaging with ultrasound or CT scan should be performed, as recommended by the most recent study 1. The initial assessment should include examination of the entire head and neck region, oral cavity, and skin to identify possible sources of infection or malignancy.
- Laboratory tests including complete blood count, comprehensive metabolic panel, and inflammatory markers (ESR, CRP) are recommended.
- If the lymph node is larger than 1 cm, persists beyond 4-6 weeks, or has concerning features (firm, fixed, or growing), imaging with ultrasound or CT scan should be performed.
- For persistent unexplained lymphadenopathy, fine needle aspiration or excisional biopsy may be necessary, as excisional biopsy is regarded as the diagnostic method of choice, allowing an assessment of the architecture of the lymph node as well as histological, immunohistochemical, cytogenetic and molecular investigations 2. Management depends on the underlying cause - infectious causes may require antibiotics such as amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days, while malignancies require oncologic referral, with treatment plans differing between the main subtypes of lymphoma, including CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP) for non-Hodgkin lymphoma, and combined chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) for Hodgkin lymphoma 1.
- Observation is appropriate for small (<1 cm), mobile nodes with benign characteristics if the patient is otherwise well.
- Reassessment should occur in 4-6 weeks to document resolution or progression. Submental lymphadenopathy commonly results from dental infections, oral lesions, or systemic conditions, so identifying and treating the underlying cause is essential for resolution, and the most recent study 1 provides guidance on the diagnosis and treatment of lymphoma, which is a potential underlying cause of lymphadenopathy.