Superficial squamous carcinoma of the esophagus, defined as carcinoma limited to mucosa or submucosa regardless of lymph node status, is being increasingly recognized in the Western hemisphere. Seventy-six cases of this entity are herein presented. Five macroscopic types were recognized: normal flat (eight cases), coarse (21 cases), verrucous (25 cases), polypoid (17 cases), and ulcerating infiltrating (five cases). Histological typing included 65 conventional squamous cell carcinomas, six squamous carcinomas with spindle cell features, and five adenoid cystic carcinomas. Four cases were strictly intraepithelial, 10 cases were confined to the mucosa, nine cases encroached onto the muscularis mucosae, and 53 extended into the submucosa. Cases with intraepithelial and infiltrating carcinomas confined to the mucosa showed no lymph node involvement. Thirty percent of cases extending into the submucosa developed lymph node metastases. Thirty-eight patients survived surgical resection from 1 to 96 months; 34 of these 38 were free of neoplastic disease. Fourteen patients had an associated bronchial or oropharyngolaryngeal carcinoma either simultaneously or asynchronously. We conclude that patients with superficial squamous carcinoma of the esophagus can benefit from early diagnosis and prompt surgery.