Excisional Biopsy: Neck Lymph Node

Side view of the neck and head showing the lymph nodes.

The lymph nodes are part of the immune system. These small organs are located throughout the body and connected to each other by lymph vessels. There are many of them in the neck. Neck lymph nodes sometimes enlarge. This is most often due to infection, but it can also be caused by cancer. Excisional biopsy helps find the cause of an enlarged lymph node. You may have already had other tests, such as a needle biopsy. But sometimes, your healthcare provider needs more information to diagnose the problem. During an excisional biopsy, the enlarged lymph node is removed. The removed tissue is then sent to a lab for study.

Preparing for the procedure

Follow the directions you were given to prepare for the procedure. Be sure to tell your healthcare provider about all medicines you take. This includes over-the-counter medicines. It also includes herbs, vitamins,  and other supplements. You may need to stop taking some or all of them before surgery. Also, follow any directions you’re given for not eating or drinking before procedure.

The day of the procedure

The procedure usually takes about 60 minutes. Most people go home the same day.

Before the procedure begins

Here is what to expect before surgery:

A small tube called an IV (intravenous) line is put into a vein in your arm or hand. This tube is used to give you fluids and medicines.

  • You will be given medicine called anesthesia to help you sleep and keep you free of pain during surgery. Local anesthesia may be injected into the area near the lymph node to numb it. You may also get medicine that provides deep sedation. This will make you relaxed and sleepy, but you will be able to breath on your own. Or, you may receive general anesthesia which puts you into a much deeper sleep. When you get general anesthesia, you will need to have a breathing tube put in and be placed on a breathing machine during the procedure.

During the procedure

Here is what to expect during the procedure: 

  • The skin over the enlarged lymph node is marked and cleaned.

  • A cut called an incision is made through the skin. If possible, the incision is made within the creases of the neck. This makes it less noticeable when it has healed.

  • The enlarged lymph node is removed. It is sent to a lab for testing.

  • The incision is closed with stitches, staples, surgical glue, or surgical strips. Then it is bandaged.

  • A tube (drain) may be placed near the incision. This drains fluids that may build up after the procedure.

After the procedure

You will be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated at first. You will get medicine to help with any pain. If you have a drain, you will be shown how to care for it. When you are ready to go home, have an adult family member or friend drive you. Follow your healthcare provider’s instructions for recovery, such as:

  • Take any prescribed medicine as directed.

  • Care for your incision as instructed.

  • Don't do strenuous activity until your healthcare provider says it’s OK.

When to call your healthcare provider

Be sure you have a contact number for your healthcare provider so you can get in touch after office hours and on weekends if needed. After you get home, call this number if you have any of the following:

  • Chest pain or trouble breathing (call 911)

  • Swelling or pain in your lower legs

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Soreness at the biopsy site that's getting worse

  • Difficulty turning your head

  • Any increased redness or swelling, warmth, worsening pain, or foul-smelling drainage at the incision site. These could be signs of infection.

  • Bleeding or bruising at the incision site

  • Numbness or tingling in your mouth, jaw, neck, arm, or shoulder

  • Problems speaking or swallowing

  • Hoarse voice that worsens


During follow-up visits, your healthcare provider will check on your healing. If you have a drain, it will be removed 1 to 2 days after the procedure. Stitches or staples are removed about 7 to 10 days after the procedure. You and your healthcare provider will also discuss your biopsy results. If cancer was found, further treatment may be needed.

Risks and possible complications

Risks of this procedure include:

  • Bleeding

  • Infection

  • Injury to the nerves near the lymph node

  • Neck abscess

  • Scarring

  • Reopening of the incision

  • Another enlarged lymph node

  • Risks of anesthesia. You will discuss these with the anesthesiologist.