Compound exocytosis occurs in many cell types. It represents a specialized form of secretion in which vesicles undergo fusion with each other as well as with the plasma membrane. In most cases, compound exocytosis occurs sequentially, with deeper-lying vesicles fusing, after a delay, with vesicles that have already fused with the plasma membrane. However, in some cells, vesicles can also apparently fuse with each other intracellularly before any interaction with the plasma membrane. In this review, we discuss the general features of compound exocytosis, and the features that are specific to particular cells. We consider mechanisms that might impose the requirement for vesicles to fuse with the plasma membrane before they become able to fuse with each other, the possibility that there are biochemical differences between vesicle-plasma membrane fusion events and subsequent secondary homotypic vesicle fusion events, and the role that cytoskeletal elements might play in the stabilization of fused vesicles, in order to permit secondary fusion events. Finally, we discuss the likely physiological significance of compound exocytosis in the various cell types in which it exists.