Squamous cell carcinoma is the most common malignancy of the soft palate. In some cases, it mimics mycobacterial infections and in others it can develop against the background of a previous tuberculosis infection. Here we report a case of a 68-year-old male who presented with squamous cell carcinoma of the soft palate. He had metastatic lymphadenopathy on the right side and, simultaneously, two caseating granulomatous lymphadenopathies without metastatic lymph nodes on the left side. The patient was treated with soft palate excision and bilateral functional neck dissection. Standard antitubercular therapy and radiotherapy were added postoperatively. To our knowledge this is the first case in the English-language medical literature of a head and neck cancer in the setting of tuberculosis. Tuberculosis may mimic head and neck cancers and vice versa, and both conditions may have atypical clinical and radiological presentations. Our case points out the need to consider tuberculosis in the differential diagnosis of squamous cell carcinoma of the head and neck.