Background <p>Laryngeal cancer incidence has declined in the Western World, but subsite-specific trends are underreported. This study assessed changes in the profile of laryngeal cancer patients in a regional cancer network.</p> Methods <p>Two patient cohorts from the west of Scotland were analysed: 326 patients diagnosed in 1999–2001 (historical cohort) and 386 diagnosed in 2018–2020 (contemporary cohort). Changes in risk factors, tumour characteristics, and treatment patterns were compared using Chi-square and Student’s t-tests. Two-year survival was assessed using the Kaplan-Meier method and Cox proportional hazards models.</p> Results <p>Overall proportion of supraglottic (C32.1) cancers increased from 38.0 to 58.0%, becoming the predominant subtype, while glottic (C32.0) cancers decreased from 56.7 to 32.6% (<i>p</i> &lt; 0.001). Early-stage diagnosis of glottic cancers rose from 65.6 to 77.0% (<i>p</i> = 0.031), while supraglottic cancers continued present at advanced stages, 70.5% vs. 64.3% (<i>p</i> = 0.24). Surgical treatment for all laryngeal cancers increased from 10.4 to 38.2%, while radiotherapy declined from 57.7 to 38.2% (<i>p</i> &lt; 0.001). Two-year risk of death for glottic cancers decreased by 42% in the contemporary cohort (<i>p</i> = 0.02), with no significant survival change for supraglottic or overall laryngeal cancers.</p> Conclusion <p>Glottic cancers now represent a smaller proportion of laryngeal cancer cases, with earlier diagnosis and improved survival outcomes. Conversely, supraglottic cancers have become more prevalent, often diagnosed at advanced stages without improvements in overall survival.</p>