Head and neck surgeon Carole Fakhry, director of the Johns Hopkins Head and Neck Cancer Center, describes the case of an adult male patient with a neck mass mistaken for a branchial cleft cyst. Once pathology revealed HPV-positive squamous cell carcinoma, he was referred to Johns Hopkins for further management. The patient met with the center’s multidisciplinary team and elected to proceed with a robotic transoral resection of the oropharynx tumor and completion neck dissection with adjuvant radiation therapy.