An extensive historical review of branchial cleft cyst carcinoma is undertaken and a critical analysis of all 67 cases reported in the English literature since Martin's landmark report is carried out and tabulated. Forty-one of the 67 cases were definitely ruled out as carcinomas of branchial cysts. Though only eight of the remaining 26 cases satisfied Martin's criterion of 5-year follow-up without evidence of primary carcinoma elsewhere, 14 patients had incontrovertible evidence of branchiogenic carcinoma, evidenced by a branchial cyst with histologic evidence of epithelial dysplasia progressing to squamous cell carcinoma within the cyst wall. Two previously unreported cases are presented. A therapeutic approach including wide local excision, radical neck dissection, and radiotherapy is recommended. A more thorough search for an occult head and neck primary, and a clearer understanding of the histopathology of branchiogenic carcinoma, are suggested as alternate requirements for this diagnosis.