Introduction: Neck lymph node metastasis with an unknown primary in the head and neck region is a common problem in the surgical oncology unit. The optimal management strategy for such patients is still not very well defined which in turn gives rise to ample confusion in the mind of the clinician. We are presenting one such interesting case where lymph node metastasis had been variously diagnosed as originating from salivary gland, thyroid and finally found to be squamous cell carcinoma with unknown primary. Case Report: A 37 year old female presented with bilateral swelling in the cervical region. Initial FNAC from both side was suggestive of mucoepidermoid carcinoma probably originating from parotid. Further workup with USG neck suggested infective pathology in the cervical swelling and also revealed lesion in the right lobe of the thyroid and isthmus. An array of investigations followed which only added to the confusion and finally b/l biopsy was done which confirmed squamous cell carcinoma in the b/l cervical swelling. B/l neck dissection followed by radiotherapy was done after histopathology confirmed it to be metastatic carcinoma. Discussion: Carcinoma of unknown primary is defined as the histological diagnosis of metastasis without the detection of a primary tumour. Cervical node metastasis with unknown primary is a common problem with incidence upto 7%. There are various treatment protocols but primary modality of choice is surgery followed by postoperative radiotherapy. The intent of treatment is curative as the lymph node metastasis represents regional spread. Conclusion: We present this unique case because of the interesting mode of presentation, the diagnostic and therapeutic dilemma it created among the various speciality clinicians involved in this patient’s care and the eventual successful intervention.