We compared 10 patients with serous surface papillary carcinoma (SSPC) to a control group of 16 patients with serous ovarian papillary carcinoma (SOPC). By definition, the ovaries were of normal size and shape in SSPC. In six cases, however, at least one ovary had focal surface irregularities. Microscopically, SSPC and SOPC differed only in the nature of their ovarian involvement. SSPC was confined to the ovarian surface or showed focal minimal invasion. Four patients with SSPC had coexistent, nonperitoneal serous-type carcinomas; three had superficial endometrial adenocarcinomas; and one had intramucosal adenocarcinoma of the fallopian tube. There were no associated carcinomas in the SOPC group. SSPC had a significantly worse prognosis than SOPC, as measured by median disease-free interval (SSPC: 3 months, SOPC: 9 months), median survival (SSPC: 12 months, SOPC: 24 months), and predicted 5-year survival (SSPC: all dead at 52 months, SOPC: 22.7%). SSPC is a clinico-pathologically distinctive variant of serous carcinoma. Because of its more aggressive clinical course, it should be distinguished from conventional SOPC with peritoneal implants.