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Surgery, radiotherapy, and chemotherapy remain standard treatment options for patients with head and neck carcinomas, but because they are often associated with complications, there is room for improvement. Although not widely practiced and still off-label, photodynamic therapy (PDT) is a promising alternative for superficial malignant or premalignant lesions of the upper aerodigestive tract. It also may be useful for those with recurrent surface disease after surgery or radiotherapy. After an historic look at the data on PDT for head and neck tumors, this article offers a current perspective from a fairly selective PDT program that has achieved dramatic lasting responses. Where PDT may fit in the treatment spectrum for head and neck cancers is one of the unanswered questions requiring further study.