Early diagnosis and treatment lead to improved survival in cancer patients. A major concern in such patients with improved survival is the risk of second primary malignancy. We report our experience, managing cancer patients with second primary malignancy. Second malignancies can be attributed to common etiological agents with primary malignancy, field cancerization, a consequence of treatment of primary malignancy, genetic syndromes and can be totally unrelated to the primary malignancy. Watchful expectancy with site–specific screening can detect the second primary without delay may help in reducing the morbidity and mortality associated with the second primary.