Patients with squamous cell carcinoma of the head and neck (SCCHN) have depressed antitumour immunity. The presence of CD4 þ CD25 þ (T reg ) cells in these patients might be, in part, responsible for downregulation of antitumour immune responses. To evaluate the frequency and characteristics of T reg in the peripheral circulation of patients with SCCHN, we used multicolour flow cytometry. Expression of CCR7, CD62L, z chain and Annexin V binding to T reg and non-T reg CD4 þ lymphocyte populations were evaluated. T reg were confirmed to be Foxp3 þ and GITR þ . The T reg frequency was significantly elevated in patients with active disease and those with no evidence of disease (NED) following curative therapies. Both T reg and non-T reg CD4 þ T cells in patients were significantly enriched in CCR7 À and CD62L À cell subsets. Although T reg in patients contained a higher proportion of double negative (CCR7 À CD62L À ) cells, the majority of T regs were CCR7 À CD62L þ . The proportion of Annexin V þ CD4 þ T cells was higher in patients (Po0.00005) than normal controls (NC), and T reg were significantly more sensitive to apoptosis than non-T reg in patients and NC. Expression of z was reduced in all subsets of CD4 þ T cells obtained from patients vs NC. The data suggest that T reg in patients with SCCHN largely contain T cells with the 'effector' phenotype, which bind Annexin V and have low z expression, consistent with their activation state and a rapid turnover in the peripheral circulation.