Records were reviewed of 108 consecutive patients with a variety of surgically approachable malignancies undergoing scalene node biopsy as part of a preoperative staging evaluation. Metastases to the scalene nodes were detected in 12 patients (11.1%). In six patients the scalene nodes were clinically suspicious before biopsy, but in six with nonpalpable nodes the scalene metastases were occult clinically. Four of the patients with clinically benign, but pathologically positive, scalene biopsies were found among the group of 62 patients with epidermoid carcinoma of the cervix. It was concluded that routine scalene biopsies are justified in the properative evaluation of cancer patients only if the nodes are clinically suspicious, except for in patients with advanced pelvic cancers, in whom the incidence of completely occult scalene metastases is 6% or more.