Mr WBMr WB 81 year old man, lives with wife81 year old man, lives with wife referred to Plas OPC for left neck massreferred to Plas OPC for left neck mass

PHxPHx low grade pancreatic neuroendocrine tumourlow grade pancreatic neuroendocrine tumour

attemptedWhipple’s resection 3/01- abandoned due to attemptedWhipple’s resection 3/01- abandoned due to bleedingbleeding

2 further laparotomies2 further laparotomies inpatient for 60daysinpatient for 60days

absence seizures since 1990absence seizures since 1990 ex smoker stopped 1972ex smoker stopped 1972

4.3mm Level 5 melanoma excised Lt cheek 4.3mm Level 5 melanoma excised Lt cheek Aug 02 - 1mm marginAug 02 - 1mm margin

wide local excision and local flap 1/12 laterwide local excision and local flap 1/12 later seen by dermatology 9/9/03 with 2 week seen by dermatology 9/9/03 with 2 week

history of rapidly enlarging nodule left history of rapidly enlarging nodule left submandibular regionsubmandibular region

CT neck performedCT neck performed FNA performed but inadequate sample FNA performed but inadequate sample

obtainedobtained

On examination On examination visible left neck mass (zone II)visible left neck mass (zone II) 4cm hard nodule4cm hard nodule not attached to mandiblenot attached to mandible Facial, hypoglossal, mental nerve function normalFacial, hypoglossal, mental nerve function normal no other lesions notedno other lesions noted

Organised a repeat FNAOrganised a repeat FNA Booked for modified radical neck dissection Booked for modified radical neck dissection

30/0930/09