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A hard, fixed mass in the supraclavicular fossa often suggests malignancy. However, a skeletal irregularity underlying the neck may also present as a hard mass, thereby simulating neoplasia. Recognition of a skeletal neck mass precludes the need for costly computed tomography (CT) scans and potentially dangerous diagnostic interventions such as fine-needle aspiration (FNA) and open biopsy. We report a case of a 15-year-old girl with a hard 3 × 3 cm mass in the supraclavicular fossa that was eventually diagnosed as an anomalous articulation of the first rib. This normal variant, which is usually asymptomatic and found incidentally during routine chest roentgenograms, has not been previously reported as simulating a neck mass. The various types of skeletal structures that may mimic a neck mass are also reviewed in an attempt to underscore the importance of the often overlooked skeletal neck mass.