A woman presents with a firm, painless, mobile mass on the lateral neck that has been enlarging over three months. What is the MOST appropriate next step?

Correct answer: B. Refer for medical evaluation and imaging

• A. ❌ Open biopsy of a neck mass is not performed in a dental office; it may seed tumor and complicate later definitive surgery. FNA under imaging comes first.
• B. ✅ CORRECT — A neck mass that is FIRM, PAINLESS and PROGRESSIVELY ENLARGING over months is a red flag for malignancy (lymphoma, metastatic carcinoma) and needs prompt medical workup — imaging and fine-needle aspiration. Referral for evaluation is the correct dental-office action.
• C. ❌ Watchful waiting for six months on a growing painless neck mass is unacceptable.
• D. ❌ Antibiotics treat reactive lymphadenitis, which is tender, acute and follows an infection. Nothing here suggests infection, and empirical antibiotics only delay diagnosis.

Note: ⚑ The source lists 'refer to physician' vs 'refer to oncologist'. Referral to the PHYSICIAN (or oral/head-and-neck surgeon) is the correct route — a tissue diagnosis has not yet been made.