In May 1978 a multimodal approach was begun for the management of patients with squamous cell carcinoma of the head and neck who presented with stage III and IV disease and whose chance of control by surgery alone was estimated to be 20 percent or less. Twenty-eight patients received two courses of chemotherapy consisting of cis-diamminedichloro platinum, vincristine and infusion bleomycin before undergoing surgery. The clinical response to this therapy judged preoperatively was surprisingly high. Three patients had no histologic evidence of tumor in the resected specimens, and toxicity was minimal. Twenty-five patients were treated surgically. No pre- or postoperative complications were attributable to chemotherapy. Three patients were treated with radiation therapy, one of whom died at 12 months with recurrent disease. Two patients died from causes unrelated to the tumor. Two patients have had recurrence of tumor. All others remain free of disease with follow-up of up ot 18 months.