Nasopharyngeal carcinoma (NPC) patients may have persistent or recurrent neck masses following radiotherapy. The clinicopathological features for these two subgroups are not fully characterized, however. In this study, we reviewed our experiences in patients with neck masses underwent either local excision or neck dissection. Between 1990 and 2004, 37 NPC patients who had persistent (n=18) or recurrent (n=19) neck masses following radiotherapy were enrolled. The clinical and pathological parameters were measured. Squamous cell carcinoma was found in the resected specimens of 72.2% of the patients (13/18) with persistent neck mass and 89.5% of the analogs with the recurrent form (17/19). Extra-nodal tumor extension was noted in 53.8% (7/13) of persistent neck malignancies and 64.7% (11/17) of the recurrent variants. At the time of the neck surgery, individuals with persistent neck malignancies had fewer concomitant distant failures (23.1%, 3/13) as compared to their counterparts with the recurrent form (58.8%, 10/17) (P=0.07). At the end of the follow-up, however, the rates of local and/or distant failures were both high for the persistent (92.3%, 12/13) and recurrent groups (76.5%, 13/17). In conclusion, following radiotherapy for NPC, both persistent and recurrent neck masses were associated with a high rate of squamous cell carcinoma. Although patients with persistent neck malignancies have significantly fewer additional sites of failures at the time of their neck surgeries, they tend to develop local and/or distant recurrences later during follow-up.