Approach to head and neck masses (pediatrics) Quiz: Ace Your Exams

A 9-year-old boy is brought to the clinic for evaluation of a neck mass that has been gradually enlarging over the past three weeks. The parents report that the mass appeared without any known trauma or illness and has grown steadily. The child has no pain or tenderness at the site, but he has developed intermittent night sweats over the past few days. There is no history of fever, recent infection, or animal exposure. Immunizations are up-to-date, and there is no history of radiation exposure. Vitals are within normal limits. The child is breathing comfortably, without signs of airway compromise. A firm, non-tender, immobile mass measuring approximately 4 cm is palpated along the left lateral neck, just superior to the clavicle. The borders are irregular, and the mass does not transilluminate. There is no erythema or warmth over the mass, and there are no enlarged lymph nodes appreciated in the axilla or groin. Oropharyngeal exam is unremarkable. Which of the following is the most appropriate next step in management?