The purpose of this review is to delineate the spectrum of neuroendocrine (NE) carcinomas of the larynx, thereby highlighting the histologic criteria differentiating these lesions. The importance of the histologic type impacts on and correlates with appropriate treatment modalities, and ultimately reflects on prognosis. A morphologically based classification scheme that incorporates both the histology and biology of each subtype is recommended. In this way, a more standardized nomenclature for these NE tumors is suggested, especially for NE carcinomas previously designed as atypical, pleomorphic, or malignant carcinoids. The distinction between laryngeal NE carcinomas (LNEC) and other malignant proliferations may be difficult when based solely on the morphologic appearance. An analysis incorporating clinical, histochemical, immunocytochemical, and ultrastructural parameters of the NE carcinomas as well as similar appearing lesions is detailed.