Head and neck cancer in pregnancy is a rare disease and difficult to manage. Few case reports exist in the medical literature. We present the case of a pregnant woman with squamous cell carcinoma of the oral cavity. While initial management in the general population may consist of surgery and, if not possible, concomitant chemotherapy and radiation, these modalities were not an option for this patient given her pregnant state. As an alternative, she was treated through gestation with neoadjuvant chemotherapy. She experienced significant reduction in tumor size and associated symptoms, and fetal growth remained normal and there were no fetal myelosuppresive effects noted at birth. Risks of chemotherapy and radiation in pregnancy are reviewed.