This 20-year (1965-1985) retrospective review identified 241 children under the age of 19 years who presented with a malignancy of the head and neck. Hodgkin's disease and other malignant lymphomas predominated, accounting for 59% of the total number of cases. Soft tissue sarcomas, specifically rhabdomyosarcoma, were the next most common lesions (17.5%). Thyroid carcinomas (10%), neuroblastomas (5%), nasopharyngeal carcinomas (5%), salivary gland malignancies (2.5%), and malignant teratomas (1%) accounted for the remaining cases. The neck was the primary site of presentation, followed by the naso-oropharynx, orbit, face and scalp, salivary glands, and aural region, in descending order of frequency. Advances in the diagnosis, staging and treatment of children with malignant tumors of the head and neck have occurred since the last comprehensive survey of such lesions was published in 1973. Otolaryngologists must be aware of these advances in order to remain active members of a multi-discipline team responsible for the care of these children.