Branchial cyst: a diagnosis of exclusion

The incidence of cancer in lateral neck cysts which were clinically diagnosed as branchial cysts was assessed retrospectively in two different periods in two different geographical locations over a period of 12 and 10 years. The incidence of cancers in these clinically benign cysts was nearly 14%. Although clinically these are labelled as branchial cysts, they ought to be investigated as cystic metastases from a nearby primary cancer, usually the tonsil, and a concerted search for a primary site ought to be made at the same time as excising them for histology.