Tumour growth involves two essential deviations from the normal state including the induction of proliferative stimuli, and simultaneous suppression of potentially compensatory cell death. It has been suggested that the development of invasive cancer involves a progressive switch from predominantly apoptotic to necrotic tumour cell death. The presence of tumour necrosis in pathologic specimens may not only reflect tumour biology, but also provide additional beneficial prognostic information. This review emphasises the role of tumour necrosis as an additional prognostic factor for patients with certain types of epithelial neoplasms.