The collapse of massive molecular clumps can produce high mass stars, but the evolution is not simply a scaled-up version of low mass star formation. Outflows and radiative effects strongly hinder the formation of massive stars via accretion. A necessary condition for accretion growth of a hydrostatic object up to high masses M ≳ 20M⊙ (rather than coalescence of optically thick objects) is the formation of, and accretion through, a circumstellar disk. Once the central object has accreted approximately 10 M⊙ it has already evolved to core hydrogen-burning; the resultant main sequence star continues to accrete material as it begins to photoevaporate its circumstellar disk (and any nearby disks) on a timescale of ∼105 yr, similar to the accretion timescale. Until the disk(s) is (are) completely photoevaporated, this configuration is observable as an ultra-compact Hii region (UCHii). The final mass of the central star (and any nearby neighboring systems) is determined by the interplay between radiation acceleration, UV photoevaporation, stellar winds and outflows, and the accretion through the disk.

Several aspects of this evolutionary sequence have been simulated numerically, resulting in a “proof of concept”. This scenario places strong constraints on the accretion rate necessary to produce high mass stars and offers an opportunity to test the accretion hypothesis.