Thirty-eight patients with squamous cell carcinoma of the buccal mucosa were treated by surgery at our clinic during the 22-year period from April 1976 through March 1999. The average age of the patients was 61.1 years. The distribution of clinical stage according to the TNM (1997) classification was as follows: stage I, 5 patients; stage II, 12; stage III, 8; and stage N, 13. Thirty-one patients received preoperative chemotherapy consisting of bleomycin alone or in combination with other agents such as cisplatin, methotrexate, or 5-f luorouracil; 5 received preoperative chemoradiotherapy. Response of the primary lesion was evaluated as complete response in 5 patients and partial response in 11. All patients underwent surgical resection. Local and partial excisions were performed via the oral route in 18 patients, through and through excision in 5, and composite operation in 15. Neck lymph node metastasis was histologically confirmed in 12 patients at primary operation and secondary metastasis was confirmed in 2. Primary closure of the surgical defect was done in 10 patients. A local mucosal flap was used in 5 patients, an artifical mucous membrane such as TERUDERMIS® in 14, and a skin graft in 3. Distant flap reconstruction was required in only 6 patients. The local control rate for all patients after initial treatment was 78.9%. Five-year cumulative survival rates calculated by Kaplan-Meier's method were 76.5% for all patients, 100% for those with stage I or III disease, 72.9% for those with stage II disease, and 51.9% for those with stage IVA disease.