Question: A 34 year old female presents with a parotid mass. She has noted a steady increase in size over the last 3-4 months. She notes that the mass has become somewhat tender over a similar interval. She has no facial weakness, no overlying skin changes, and no adenopathy. CT reveals a predominantly solid, homogeneously enhancing 2 cm tail of parotid mass. Which of the above features is most concerning for malignancy? [Answer will be posted with next week's new question]

Answer to last week's question, "Show Me A Sign" (August 29, 2016):

Panendoscopy with directed biopsies. If after doing so a primary site is not identified, many authors would perform ipsilateral or bilateral tonsillectomy with tongue base resection.