727 patients with squamous cell carcinoma (SCC) of the lip and oral cavity have been followed for the occurrence of second primary tumours (SPTs) in the respiratory and upper digestive tract (RUDT). 74 patients (10%) developed at least one SPT in the RUDT. The incidence of SPTs was expressed per 1000 person-years of follow-up. In our study about 28 SPTs per 1000 person-years of follow-up were seen in the RUDT. Patients were at risk for a second primary tumour, at a steady rate of approximately 2.8% per year during at least 10 years. Furthermore, patients with an index tumour in the lower part of the mouth (floor of mouth, retromolar area and lower alveolar process), which is more related to tobacco and/or alcohol, seem to be more at risk for SPTs than patients with an index tumour in the other (sub)sites of the mouth.