Forty cases of cervical (excluding supraclavicular) node metastases from unknown primary tumors were observed at the medical oncology department of a large general hospital. Histologically they were epidermoid carcinoma (18 cases), undifferentiated carcinoma (16 cases) and adenocarcinoma (6 cases). In 8 patients the primary was subsequently diagnosed. Four patients were untreatable or refused treatment when diagnosed. The 3-year survival of the 36 treated patients was only 22% - indicating a poor prognosis is for this uncommon form of presentation. Patients should be treated as aggressively as possible in an attempt to eradicate the occult primary.