Solitary cystic masses in the lateral neck can present a significant diagnostic dilemma as they can be metastases from tumours of the oro or nasopharynx. This retrospective paper detailed all patients presenting to a university hospital in Germany, from September 2011 to November 2013. Patients with a clinically apparent tumour were excluded and 131 patients were included in the study. All 69 male and 62 female patients had a full preoperative examination including ultrasound examination of the neck. In 58 patients, USS guided FNAC was performed - all these were reported negative for malignancy and supported a diagnosis of a cystic lesion. Twenty-five patients had already had imaging (elsewhere) reported as no signs of malignancy. All 131 patients went on to have surgical excision of the neck lump, and 12 out of this 9.2 % had a malignant tumour. HPV DNA was detected in all examined cystic tumours. All patients with a malignant disease went onto have panendoscopy, bilateral tonsillectomy, and biopsies of the tongue base and nasopharynx. A primary tumour was only detected in 10 cases. None were detected on FNAC or ultrasound. No patient had a PET CT. The authors conclude that in patients aged 40 and older presenting with a solitary lateral neck mass, a carcinoma is expected in 22% of cases. Interestingly, 90.8% of lateral cervical cysts were HPV negative but all lateral cystic metastatic lymph nodes showed HPV association. Thus, a solitary lateral cyst with HPV DNA is likely to a metastasis of an HPV-associated SCC. This is a good short paper and reminds the reader of the complexity of diagnosis of a solitary cervical cystic mass.