The use and limitations of fine-needle aspiration (FNA) of lesions of the parotid gland are known, but those of nonparotid lesions of the head have been described only sporadically. We conducted this study to evaluate the utility of FNA and to analyze the causes of diagnostic discrepancies for these lesions. A total of 6,898 FNAs of different sites was performed at our institutions between January 1991-August 1998, and 214 (3.1%) of the cases were FNAs of nonparotid lesions of the head. The most common diagnosis of nonparotid lesions was squamous-cell carcinoma, in 22% (n Ο 48), and the most common site aspirated was the scalp, in 34% (n Ο 73). Lipomas and keratinous cysts comprised 5% (n Ο 9) of the total. A statistical analysis was conducted on 98 paired cytology and histology (n Ο 83) and cytology and flow cytometry (n Ο 15) specimens (70 malignant and 28 benign). FNA recognized the malignant and benign nature of the lesion in 60 and 26 cases, respectively, with 86% sensitivity, 93% specificity, and 88% accuracy. Causes of false-negative FNA diagnoses (n Ο 10) included sampling error (n Ο 6), bloody smears with scant cellularity (n Ο 3), and bland cytomorphology (n Ο 1). Florid granulation tissue and a mucocele of the tongue accounted for the two false-positive cases. We conclude that FNA is an effective tool for triage of surgery candidates with nonparotid lesions of the head. Adequate samples with suffΔ±cient cellularity are required for avoiding false-negative diagnoses. Occasionally, tissue biopsy is needed for diagnosis of equivocal cases.