Purpose: Field cancerization leads to patients with an upper aerodigestive tract squamous cell carcinoma (SCC) demonstrating high risk of developing a second primary malignancy (SPM). Given the extensive treatment many have already received, the treatment of a SPM is very challenging and traditional teaching holds that its development is a dire situation with a guarded prognosis. However; disease, risk factor and treatment patterns are changing over time and we sought to define if this remains a truism in a modern dataset. Methodology: The University of Calgary maintains a prospectively annotated database of all head and neck patients treated in Southern Alberta since 2009. Patients were divided into groups based on primary vs secondary cancer. Chi square and fishers exact tests were used to compare patient and tumour characteristics. Cox regression analysis was used to analyse recurrence free, disease free and overall survival. Results: 3121 patients were treated for head and neck SCC since 2009. Of these, 70 patients were treated for a SPM. Groups were similar apart from a higher likelihood of being male and of receiving single modality treatment in the SPM group (p=0.039 and p=0.044 respectively). SPM had a protective effect with regard to both disease specific and recurrence free survival (RFS) at 3 and 5 year time points. When accounting for T stage, lymphovascular invasion and extravapsular spread this trend persisted but only reached statistical significance for 5 year RFS. Conclusion: Contrary to traditional teaching; outcomes in SPM are at least as good as those with a first cancer in our cohort of patients. This has clinical implications with regard to treatment decisions and cancer surveillance.