Introduction: Second primary tumour (synchronous or metachronous) is increasingly being reported but in most of the cases lung and oral cavity or oropharyngeal carcinomas have been described in association with carcinoma of the larynx. Case report: The occurrence of nasopharyngeal carcinoma as a metachronous second primary in a case of carcinoma of the larynx is very uncommon. This is a rare case of such an association. Conclusion: This case highlights the need of long term follow up of all head & neck malignancy patients. A very high degree of suspicion should be maintained to initiate thorough examination including nasopharyngeal examination either by endoscopy or clinically in order to expedite the diagnosis of second primary.