The patient was a 66-year-old Chinese woman who presented in another hospital 3 years ago with a slowly enlarging left cheek swelling for a few months. The swelling measured about 3 cm in diameter, hard in consistency and was situated in the parotid gland on radiological examination. Partial parotidectomy was done and specimen (S1) was initially diagnosed as Langerhans cell histiocytosis associated with benign glandular proliferations focally extending to margin. The regional lymph node sampled showed reactive changes with increased Langerhans cells. After 2 years, the patient noticed recurrent cheek swelling over the same site. Clinical-radiological work-up revealed a recurrent mass in the parotid gland associated with enlarged regional lymph nodes. Biopsy of the swelling showed frank carcinoma and was reported as sclerosing mucoepidermoid carcinoma with eosinophilia. The patient was then transferred to our hospital for further management. Radical parotidectomy sacrificing the lower branches of the facial nerve with reconstruction using the sural nerve, and regional lymph node dissection were performed. The specimen was subsequently sent for pathological study. Post-operative external radiotherapy to the neck was administered and the patient was free from disease 6 months after operation.