After an initial coarse needle biopsy without meaningful results, a histological diagnosis of a squamous cell carcinoma metastasis, HPV-associated, was made during a panendoscopy without evidence of a primary tumor with lymph node extirpation from level V. At the interdisciplinary tumor conference, after performing PET-CT diagnostics with no evidence of a primary tumor, the decision was made to perform a CUP panendoscopy and neck dissection on the right. No further questions after detailed preoperative discussions.