The aim of this article is to report a case of necrotizing sialometaplasia with long-term follow-up. A case of necrotizing sialometaplasia in a 37-year-old man with clinical documentation on the progress during a 2-year follow-up is presented. Data from an extensive review of the literature including clinical, imagenologic, and microscopic features are provided. Information on diagnostic and prognostic factors is offered and comprehensibly discussed. The importance of identification and diagnosis of this entity during the review of the slides from the first biopsy is stressed and the exclusive performance of an incisional biopsy is debated. The presented clinical photographs reveal the clinical changes of the lesion from the beginning of the lesions up to 2 years follow-up, documenting the complete long-term clinical course and the healing process of this entity. Keywords: necrotizing sialometaplasia, oral squamous cell carcinoma, salivary gland lesions, salivary glands