<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Neck masses are a common complaint in children worldwide, and constitute a major indication for surgical consultation in many pediatric surgical centers. Most of the neck masses in children are benign in their nature and clinical course. The broad spectrum of etiology of neck masses that ranged from congenital benign to acquired neoplastic lesions is varied and related to multiple factors. This retrospective study was done with the objective to assess the distribution of neck masses related to gender, age, pathology, and anatomical location of neck masses in Aseer Central Hospital. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Medical records of 62 patients with neck masses were collected from the department of pathology at Aseer Central Hospital KSA. The cases were reviewed for data on gender, age, the type of origin tissue, the type of lesion, and the anatomical location. Comparison between genders, age groups, and tissue origins were performed. All statistical tests were performed with SPSS software. We exclude thyroid, parathyroid and salivary gland masses.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Over a period of 5 years, a total of 62 patients 53.2% and women 46.8% had neck masses resected for pathological assessments. The age of presentation was ranging from 1 to 14 years. 22.6% developed in (from 1 years to 5 years old), 38.7% developed in (6 to 10 years), and 38.7% developed, in (11 to 14 years). The histopathological diagnosis of the neck masses were congenital 40.3%, inflammatory 33.9%, and malignant tumor 25.8%. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The differential diagnosis of the pediatric neck mass includes a wide array of congenital, inflammatory, benign and malignant lesions. The exact diagnosis may only be obtained by histopathological examination. In our study the most common masses in pediatric patient thyroglossal duct cyst, all midline masses are congenital.</span></p>