Two patients with extrapulmonary small cell carcinoma localized in the neck survived for more than two years without systemic therapy. This suggests that there may be a subset of small cell carcinomas characterized by slow growth, resulting in an indolent clinical course. By light and electron microscopy, we were unable to identify features of this indolent form which differ from those of the aggressive form of pulmonary or extrapulmonary small cell carcinoma.