Between 1984 and 1992, 18 cases of cervical metastasis of squamous cell or anaplastic carcinoma (1% of all head and neck tumors) were seen at the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). Fifteen patients underwent radical surgery: 1 N1, 4 N2A and 10N3, N1 and N2A patients underwent surgery followed by radiotherapy. The 10 N3 patients began with neoadjuvant chemotherapy (cisplatin and 5-fluorouracil), then 8 had radical neck dissection and 2 had palliative radiotherapy. The primary tumor was found in 11%. The 5-year survival rate was 40% in N1+2A and 11% in N3. Chemotherapy did not improve survival in advanced disease, but it facilitated neck dissection and selection of the group with the prognosis.