Background: Head and neck malignancies are often diagnosed at a late stage in sub-Saharan Africa including Tanzania, thus resulting in a generally poor prognosis. The reason for this sad experience is not known. This study was undertaken in our local setting, to describe the stage at presentation and factors associated with late diagnosis of head and neck malignancies at Bugando Medical Centre, Mwanza, Tanzania. Methods: This was analytical cross sectional study involving all patients confirmed to have head and neck malignances at Bugando Medical Center from February to June 2019. Results: Out of 60 patients enrolled in the study, 35(58.3%) were males and 25(41.7%) were female making a male to female of 1.4:1. The mean age was 56 [range, 12-89] years. Majority of patients, 44(73.3%) presented with advanced (late) stage of the disease, with stage III been the most prevalent stage accounting for 49.3% of cases. Only one (1.7%) patient had stage I tumor involving the oral cavity. Distant metastasis was documented in only 16.7% of cases. The oropharynx was the most common anatomical site for head and neck malignancies (n=18, 30%). Patients with oropharyngeal malignancies were associated with late-stage presentation whereas those with laryngeal malignancies were associated with early-stage presentation. Patient-related factors such as rural residence (p-value = 0.048) and use of local herbs (p-value = 0.001) were significantly associated with advanced (late) tumor stage at presentation. The level of health care facility first visited (p-value = 0.876) and the number of referrals (p-value =0.579) were not significantly associated with late stage at presentation. Conclusion: This study demonstrated that the head and neck malignancies are not uncommon at Bugando Medical Center and the majority of patients present late with advanced stage cancer. Therefore, increasing awareness among rural residence regarding head and neck malignancies and their symptoms, and training ......