Histopathological assessment of formalin-fixed biopsy tissue and surgical resection specimens remains the cornerstone of cancer diagnosis and pathological staging in routine clinical practice. In recent years, standard protocols for reporting head and neck cancer have been widely used and these have improved the general level of the pathological assessment. In this article, we look beyond the standard protocols and deal with potential difficulties and pitfalls in the assessment of incisional biopsy specimens, surgical resection specimens and neck dissections. We draw attention to possible shortcomings and issues requiring clarification. Emphasis is given to precise histopathological definitions, histopathological detection and differential diagnosis. The approach is a practical one--a consideration of common experiences and dilemmas faced by the reporting pathologist, and where possible, we offer guidance and practical tips. The article concludes with a brief consideration of the prognostic value of accurate histopathological staging.