Ionizing radiation is an established curative therapeutic modality in the management of neoplasms. However, it is well recognized that radiation is also carcinogenic to bone and soft tissues. In the head and neck, radiation-induced tumors are uncommon despite the large numbers of patients treated by primary or adjunctive radiotherapy. However, with patients living longer, the risk of radiation inducing a tumor in previously irradiated areas is increasingly possible. Because of the case reports and the increasing numbers of patients who are surviving many years, clinicians must be conscious of changes in patients treated with radiation, and may suggest a thorough work-up to exclude a new tumor. The possibility of a second squamous cell carcinoma tumor arising after several years in a previously irradiated squamous cell carcinoma site, such as the larynx, must be considered a metachronous carcinoma not related to previous irradiation. The use of radiotherapy for the treatment of patients with benign head and neck neoplasms should be recommended with caution, and complications of such treatments should be documented in the literature when they arise.