Synovial sarcoma is the commonest sarcoma of the hands and feet. There have been, however, only nine reported cases of synovial sarcoma of the head and neck region. These cases had very limited followup, with only one death directly attributable to the tumor. Based on this evidence, it had been concluded that the tumor behaved in a more benign fashion in the head and neck region. Our experience with a case of a particularly aggressive cervical synovial sarcoma led us to update information on the previous cases. Two patients have subsequently died due to recurrence of the sarcoma. The pattern which appears to have emerged is that of a most aggressive neoplasm. The best results thus far have been obtained with a combination of radical surgery and radiotherapy.