Cervical teratomas in the newborn are uncommon and difficult management problems, as their natural history and prognosis are not well defined. Existing or potential airway obstruction is usually the main concern in acute management of these patients. Total excision is essential to avoid local recurrence in benign lesions, and a small but present risk of malignancy can result in death from metastatic lesions which appear later. A unique case of neonatal malignant cervical teratoma with large congenital metastatic lesions present in liver, lung, and buttocks was successfully managed. Magnetic resonance imaging (MRI) was invaluable, both in delineating these lesions and in planning a four-stage curative resection of all macroscopic disease. Such a case has not been reported previously.