Background: Esophageal carcinoma is one of the most lethal gastrointestinal (GI) malignant tumors worldwide. The disease is known to have a high incidence in northern Iran; however, its condition in the South is not much clear. Objective: In this retrospective study we investigated the epidemiology and time trends of esophageal carcinoma in Fars Province, South of Iran. Methods: In a retrospective study, we reviewed pathologic reports of all laboratories in Fars Province, South of Iran, from March 1997 to March 1999 to find cases of esophageal carcinoma. Annual and average incidence in different age groups were calculated for both sexes, based on four censuses results. Results: Esophageal carcinoma was the third most common GI cancer in Fars, with an average incidence of 2.95 per 100,000 in the population older than 15 years. The incidence of esophageal carcinoma was found to drop by 64% during the study period. This was mainly due to the decreased incidence of squamous cell carcinoma. Females developed squamous cell carcinoma in relatively younger age as compared to males. Conclusion: Our region in the South of Iran is one of the low incidence areas of esophageal carcinoma as compared to that of northern borders of the country and other parts of the world with some special features.