Spindle cell carcinoma is an unusual variant of squamous cell carcinoma. The histogenesis of these tumors is controversial, as is the prognosis for patients with spindle cell carcinoma of the head and neck when compared with all squamous cell carcinomas of these sites. Fifteen consecutive nondermal cases of spindle cell carcinoma of the head and neck were reviewed. Six patients had spindle cell carcinoma either in recurrent tumor or in neck metastases following treatment for squamous cell carcinoma where a spindle cell component was not initially noted. Despite aggressive management, 13 patients have died from their disease. The histogenesis and management of spindle cell carcinoma of the head and neck are discussed.