Only 3 per cent of all melanomas arise in the mucosa of the head and neck region. Melanomas of mucosal origin in this series differed from their cutaneous counterpart in that size of the primary lesion did not influence prognosis. Regional lymph node metastases were infrequent and did not seem to influence prognosis. Nearly all the primary lesions on microscopic review showed the presence of intralesional lymphatic and blood vessel invasion. Local recurrence at the primary site was the most common cause of treatment failure, in spite of seemingly adequate surgical resection. Surgical treatment offers long-term cure to only a limited number of patients.