Background: Head and neck cancers are among the top ten malignancies worldwide. Their true extent is lacking in Ghana. There is no known published data covering the subject among Ghanaians. Aim: To determine the incidence of primary head and neck cancers seen at Korle Bu Teaching hospital, Ghana. Methods: A retrospective study of histopathological records of diagnosed head and neck cancers from 1989-2008. Results: 2,041 of 4,546 reports were malignant. 1342 were primary cancers. These were studied further in detail. The male: female ratio was 1.84:1. The oldest patient was 95 years and the youngest less than 1 year. The mean age was 45.08 years with a peak age-group of 51 to 60. The incidence of tumours in female exceeded that of male in only one age-group (81-90), with a ratio of 0.62:1.... There were 59 different tumours. 45 of these occurred less than 5 times. Of those diagnosed, more than 5 times adenocystic carcinoma, osteosarcoma, chondrosarcoma and rhabdomyosarcoma occurred more frequently in females than males. 23 occurred only once. Squamous cell carcinoma (n=624) was the commonest pathology, followed by non-Hodgkin’s lymphoma (n=256), nasopharyngeal carcinoma (n=100), Hodgkin’s lymphoma (n=97) and adenocystic carcinoma (n=55). Conclusion: We observed a rising incidence of head and neck cancer. Squamous cell carcinoma is the commonest, occurring more commonly in men than women. The gender ratio is similar to that seen in most countries. This study offers a benchmark for future studies, planning resources and monitoring the efficiency of efforts to manage the different pathologies.