The investigative procedure of clinically diagnosed cervical lymph node metastases is discussed. Cervical lymph node metastases can be the first manifestation of a carcinoma. The corresponding primary tumor is diagnosed in the ENT area (mouth, pharynx, larynx) in 80% of the cases and in bronchi or esophagus in 10%; therefore, a detailed ENT examination and an upper panendoscopy must be undertaken. Wedge excisions of lymph node metastases are contraindicated, since they produce an artificial rupture of capsule and open the door to extranodal tumor growth. Excision of cervical lymph nodes, which are clinically related to a cervical lymph node metastasis, should only be carried out within the framework of a diagnostic and therapeutic concept.