Background
Primary malignancy arising from branchial cysts is a debatable diagnosis. Some argue that the condition is actually metastatic disease presenting as a neck cyst. Does the knowledge of HPV-related head & neck squamous cell carcinoma add to the debate?

Objective
We present the case of a man with HPV-related squamous cell carcinoma of the neck. Having investigated him thoroughly, we believe that primary branchiogenic carcinoma is the most likely diagnosis. We will discuss management of this case and further the debate on primary branchiogenic carcinomas.

Results
This was a case of a gentleman who presented with a neck cyst. Pre-operative  investigations suggested a branchial cyst. However, histolopathological studies  indicates HPV-related squamous cell carcinoma arising from a branchial cyst.

Conclusion
Cystic squamous cell carcinoma of the neck can be a diagnostic challenge as it can masquerade as seemingly benign branchial cysts. A high index of suspicion is required in managing these cases.

Are primary branchiogenic carcinomas still relevant in the era of HPV-related carcinomas of the head & neck?