To investigate p53 alterations in esophageal squamous-cell carcinomas of patients in the high-risk area of southern Thailand, 72 paraffin-embedded samples were analyzed immunohistochemically for p53 protein expression and 16 frozen samples for p53 mutational status. Forty-two of the 72 tumors (58.3%) showed p53 protein accumulation in the nuclei of tumor cells. Expression of p53 in tumors was not significantly correlated with gender, histological grading, depth of invasion, node involvement, smoking or alcohol consumption. Analysis of the p53 gene in a sub-set of 16 tumors showed mis-sense mutations in 7 out of 11 p53-positive and 1 out of 5 p53-negative tumors. The p53 mutational spectrum was 50% transitions (3 C-to-T and 1 G-to-A, all occurring at CpG dinucleotide sites) and 50% transversions (one each, C-to-G, G-to-T, T-to-G, and T-to-A). Our findings support the hypothesis that alterations of p53 are involved in the carcinogenesis of most squamous-cell carcinomas of the esophagus, irrespective of the population and the factors responsible for carcinogenesis. The mutation profile of the p53 gene might indicate etiologic contributions of different mutagen exposures in patients from high-risk areas of southern Thailand.