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Metastatic tumors to lymph nodes form the main body of neck masses and cystic lesions in the adult patients. The primary malignancies often found in head and neck regions are breast, melanoma, lung, thyroid, or occult metastatic squamous cell carcinoma. That being said, benign primary neck lesions such as branchial cleft cyst, thyroglossal duct, etc., should be carefully differentiated from metastatic tumors. An overtreatment such as neck lymph node dissections, could result if these benign entities are misdiagnosed as a metastatic cystic squamous carcinoma.