A retrospective analysis of 877 patients who had malignant melanoma of the head and neck identified 366 patients who developed recurrent disease. Sex, race, age, histology, Clark level, thickness, ulceration, lymph node status, lymph node dissection, site of recurrence, and time to recurrence were analyzed to determine their effect on survival following the development of recurrent disease. Survival following the development of recurrence was found to be influenced by the site of first recurrence and the age of the patient at the time of recurrence. For a given age, patients who had initial recurrences at distant sites were three times as likely to die following recurrence than patients with local recurrence. Patients who had initial recurrences at distant sites were twice as likely to die following recurrence than patients with regional sites of recurrence (p less than 0.001).