Head and Neck is a complex area inundated with innumerable pathologic lesions. Though diverse in appearance, such lesions are heavily weighted on the architectural and histopathological patterns that can provide valuable clue for their broader diagnosis. A wide array of pathologic lesions depict a spindled architecture histopathologically thus presenting as spindle cell lesions. The histological diagnosis of spindle cell lesions of head and neck can be challenging owing to their overlapping and subtle histopathologic patterns which could hinder a confirmed diagnosis. This textbook provides a systematic classification of spindle cell lesions also summarizes the Immunohistochemical features of spindle cell lesions of different origin, accentuating their diagnostic endowment in each lesion amidst obscure histopathological patterns and other techniques.