The frequency of distant metastases was studied in 112 patients who had squamous cell carcinoma of the head and neck. All of these patients died of the tumor and underwent postmortem examinations. Forty-one (37%) of the 112 patients had distant metastases at the time of death. There was a significant correlation between development of distant metastases and the presence of cervical nodes. Of the patients who had distant metastases, 63% had evidence of tumor in the cervical nodes, whereas 37% of these patients were free of disease in the neck. Patients with residual or recurrent tumors in the cervical nodes had a high risk of distant metastases.