An unusual case of upper cervical carcinoma probably of true branchial origin is presented and the literature relevant to this condition reviewed. Branchiogenic carcinoma is a rare condition and should not be diagnosed in the absence of the 4 criteria laid down by Dr Hayes Martin, viz. that the carcinoma should arise in the wall of a branchial cyst, that it should occur along a line from the tragus to the clavicle along the anterior border of sternomastoid, that the histology should be compatible with the branchial apparatus and that no other primary tumour should come to light in a 5-year follow-up. A fifth criterion, ie. the demonstration of premalignant changes in the epithelium of the cyst, is suggested to aid a conclusive diagnosis.