Spindle cell neoplasms are defined as neoplasms that consist of spindle-shaped cells in the histopathology. Sarcomatoid carcinomas are biphasic tumors i.e. epithelial cells and spindle cells. These tumors have been proven to be monoclonal dedifferentiated forms of conventional squamous carcinomas. In the oral cavity, the origin of the spindle cell neoplasms may be traced to epithelial, mesenchymal and odontogenic components. Diagnosis of sarcomatoid squamous carcinoma is challenging because of overlapping histopathological features with other spindle-cell tumors. Spindle cell carcinoma of head and neck is a subtype of squamous cell carcinoma and is a unique and rare neoplasm. It has a more aggressive behavior as compared to classical squamous cell carcinoma warranting surgical interventions with wider surgical margins. It is very difficult to diagnose these neoplasms from routine haemotoxyline and eosin sections of histopathology. Immunohistochemistry along with routine histopathology is essential in establishing the diagnosis of spindle cell carcinoma. Surgery and radiotherapy form the mainstays of treatment.