Regional metastases from head and neck cutaneous tumors are uncommon, and most present within 2 years from initial diagnosis. Occasionally such metastases may manifest at a later date, increasing the possibility of being derived from a second noncutaneous primary cancer of the head and neck region. The authors studied the course of disease in patients treated for cutaneous neoplasms manifesting with delayed regional metastases. They evaluated patients treated for cutaneous neoplasms with regional metastases presenting more than 3 years from initial treatment. There were 10 cases of squamous cell carcinoma, one case of basal cell carcinoma, and one case of basosquamous carcinoma. Mean duration from initial diagnosis to presenting neck metastases was 4 years 2 months. Mean overall follow-up is 2 years 5 months, and 3 years for patients alive without disease. Four patients died of unrelated causes and 3 patients died of their disease. Five patients are alive and free of disease. A diligent search for a second primary must always be carried out when neck metastases appear. Yet, delayed regional metastases appearing more than 3 years after resection of skin neoplasms is not uncommon and are usually associated with the primary skin cancer. Prolonged follow-up is essential, even in T1 patients. Patients with regional recurrence should be treated aggressively.