The existence of branchiogenic carcinomas is questioned in this review, which also discusses the different possibilities in an adult patient who presents with a cystic swelling in the upper lateral aspect of the neck. Most cases of branchiogenic carcinomas reported in the literature may actually have been secondary metastatic lesions from an occult tonsillar carcinoma. We will also discuss the different features of cystic metastasis that distinguish them from solid metastasis, and explain why oropharyngeal carcinomas with cystic neck metastasis should be in a separate category from other head and neck cancers.