In patients with neck masses, accurate history taking and physical examination often narrow the differential diagnosis tremendously. Diagnostic tests may be helpful but should be done only if management is affected as a result. Fine-needle aspiration, when necessary, is often valuable to obtain a tissue diagnosis, but its accuracy may depend on the experience of the cytopathologist. Antibiotic therapy is sufficient for some inflammatory masses; excision is generally needed for congenital lesions and malignant neoplasms.