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Design and Setting. A retrospective study was conducted on all 2WW referrals made to our tertiary head and neck centre in a 12-month period. Methods. Sensitivity, specificity, and PPV of presenting complaints in H&N cancer diagnosis using Excel® and the statistical package SPSS®. Results. The sensitivity and specificity of 2005 NICE guidelines in detecting H&N cancers were 91.2% and 59%, respectively; their PPV was 9%. The sensitivity and specificity of 2015 NICE guidelines were 75.4% and 71%, respectively; their PPV was 10.3%. Eight out of 85 patients who presented with unilateral sore throat for more than 4 weeks, with or without otalgia and normal otoscopy, had H&N cancer (PPV 9.5%). Conclusions. Although the 2015 NICE guidelines have a high rate in detecting H&N cancers, consideration of reincluding unilateral sore throat in the referral criteria might be necessary. [ABSTRACT FROM AUTHOR]

A woman in her 70s presented to a tertiary otorhinolaryngology outpatient department with a 25-year history of right-sided subcutaneous neck lesion that had steadily grown over the preceding 6 months, now with skin involvement. The patient was asymptomatic except for some mild tenderness. The 3 × 3 cm mass lay fixed to deep tissues adjacent to the sternocleidomastoid muscle, though no associated lymphadenopathy was found on palpation, with imaging confirming no regional or distant metastases. Biopsy confirmed the lesion to be primary cutaneous adenoid cystic carcinoma, a malignancy not previously described as a primary on the neck, which was treated by wide local excision after multidisciplinary team discussion. The lesion was completely excised with negative margins, and after surveillance over 3 years, the patient is still well with no signs of recurrence., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)