Head and neck squamous cell cancers (HNSCC) have a high local recurrence rate due to incomplete tumor resection. The use of molecular markers to establish surgical margins may decrease local recurrence. Surgical margins are determined by histopathologic analysis on frozen sections. We postulate that genetic and molecular changes precede gross histologic alterations. Tumor markers may improve the reliability of pathology examination, but those evaluated to date lack the sensitivity needed for routine clinical use. Western blot analysis showed elevated eIF4E in all 26 HNSCC in contrast to its low expression in benign lesions. Surgical margins were analysed for eIF4E in 23 patients. Twelve patients showed elevated eIF4E in histologically negative margins. Cancer has recurred in 5 of the 12 patients as opposed to none of the 11 patients with eIF4E negative margins (P= 0.02, Log rank test). This is the first report of eIF4E in HNSCC, as a sensitive and specific marker for HNSCC, with potential for defining clear resection margins. The correlation between elevated levels of eIF4E at the margins and recurrence highlights its ability to detect malignant cells prior to clear-cut alterations in morphology. The accuracy and simplicity of these assays underscore the usefulness of eIF4E in managing HNSCC.