In this retrospective study 127 patients with a squamous cell carcinoma of the nasal vestibule were evaluated. Though treated with curative intent, 23 patients eventually died with or because of tumour. Lymph node metastases were of the utmost importance and were detected in 31 patients, in two-thirds of whom the treatment was unsuccessful. Since elective treatment of possible lymph node metastases is a possibility to improve prognosis we have established a high-risk group in which metastases are to be expected and elective treatment of the neck should be considered. These patients are those with a large lesion on presentation and those with a poorly differentiated tumour.