Carcinoma of unknown primary (CUP) in the head and neck region remains a persistent and complex challenge for clinicians worldwide. Significant advances in diagnostic modalities-such as crosssectional imaging, molecular diagnostics, robotic surgery, and positron emission tomography (PET)have improved the ability to identify primary sites, especially within the oropharynx, notably HPVrelated cancers. 1,2 With the rising incidence of HPVassociated oropharyngeal carcinomas, the proportion of CUP cases presenting with regional metastases and occult primaries is also increasing, emphasizing the need for updated management strategies.