Background The aim was to describe the profile of Head and Neck Cancers (HNC) at a referral centre in South Africa. Methods Records from January 2015 to December 2017 were reviewed. Variables analysed were site, histologic type, age, sex, HIV status, p16 status, treatment intent/ modality, and the Eastern Cooperative Oncology group performance (ECOG). Results Of 854 patients, 71% were male. Median age was 58. Smoking was a risk factor in 86.3% (n=737) and alcohol in 74.2% (n=634). 53.86% (n=460) and 27.17% (n=232) had ECOG scores of 1 and 2 respectively. 9% (n=56) were HIV positive. 167 had oropharyngeal primaries, and 9.58% (n=16) were p16-positive. 53.87% (n=466) had locally advanced disease, and 47.42% (n=405) received palliative treatment. Conclusion At this centre, HNC affects older adult males of lower socioeconomic status, who often smoke and drink and present with locally advanced disease, requiring palliative oncologic care. HPV and HIV play a minor role.