This paper describes the characteristics and natural history of the largest reported group of patients with untreated head and neck cancer. From 1953 to 1990, 808 untreated head and neck cancer patients were followed-up until their death. All patients were given supportive care, but specific oncological treatment was not pursued secondary to advanced tumour stage, poor performance status and/or patients' refusal of any treatment. The overall survival ranged from 1 day to 53.8 months (median 3.82 months). Performance status was the most significant predictor of survival (P < 0.001). A subgroup of 357 patients with good performance status and aged less than 70 years old had a 12.9% 1-year survival. Approximately 50% of untreated head and neck cancer patients will die within 4 months of their diagnosis. However, the remaining patients can survive up to 4 or more years, depending on their tumour location, extent, performance status and level of supportive care.