Necrotizing sialometaplasia (NSM) is a reactive, self limiting, salivary gland lesion, first described in 1973 by Abrams et al. (Cancer 1973;32:130). NSM is an important condition because the clinical and the histologic differential diagnosis includes benign and malignant entities. When misdiagnosed as a malignancy, it has the potential to result in overly aggressive surgical treatment. NSM is relatively uncommon, which can further compound the diagnostic dilemma since differential diagnostic considerations of rare diagnoses may be overlooked.