PURPOSE: Cervical lymph node metastases are quite common in papillary thyroid cancer and the spreading route of a metastasis is usually in a sequential fashion. However, skip metastasis is not uncommon in node-positive papillary thyroid cancer. The goal of this study was to evaluate the pattern of cervical lymph node metastases in papillary thyroid cancer. METHODS: A total of the 265 patients with papillary thyroid carcinoma that underwent a total thyroidectomy and cervical lymph node dissection between January 2006 and August 2007 were enrolled in the study. Medical records were reviewed for analyses of the pattern of cervical lymph node metastasis. RESULTS: Cervical lymph node metastases were noted in 39.2% of the total cases and in 27.9% of the 197 patients that had only central lymph node dissection and 48.5% of the 68 patients that had central and lateral lymph node dissections. Among the cases of central and lateral node dissection, skip metastasis, lateral lymph node metastasis without central lymph node metastasis, was observed in 4 (5.8%) of the cases and a false positive result of node dissection was confirmed in 19 (28.1%) cases. CONCLUSION: For complete surgery of papillary thyroid carcinoma, a thorough examination of the cervical lymph node is required. Acareful consideration of the possibility of skip metastasis and false positive results in cervical lymph node dissection, especially in the lateral compartment, is necessary.