Between 1978 and 1991, 54 patients with metastatic squamous cell or undifferentiated carcinoma to the cervical lymph nodes, with unknown primary mucosal sites, were treated with curative intent at McGill University teaching hospitals. The median age at diagnosis was 58 years with a male:female ratio of 6:1. All patients presented with a painless neck mass. Five patients (9%) presented with N1 disease, 28 (52%) with N2a disease, four (7%) with N2b disease, three (6%) with N2c disease, and 14 (26%) with N3 disease. Twenty-four patients (44%) underwent neck dissection, and 30 (56%) had only excisional lymph node biopsy. Fifty-three patients (98%) were treated with radiotherapy to a median dose of 60 Gy (range 38 to 66 Gy) in 30 fractions. With a median follow-up time of 49 months, the overall actuarial survival was 63% and 59% at 5 and 10 years, respectively. Three patients were found to have a subsequent primary head and neck tumor. The single most important prognostic factor was the N stage, which influences both neck control and long-term survival. There was no statistically significance difference in survival or local neck control rates between patients who had neck dissection or excisional lymph node biopsy (p > 0.05).