**8. Conclusions**

Despite advances in imaging studies in detecting occult metastasis, the risk of occult metastases in necks categorized as N0 in patients with oral cavity squamous cell carcinoma (SCC) remains and the need for neck dissection should carefully be examined. Elective neck dissection, specifically, selective neck dissection, is recommended for Stage II oral cavity carcinoma given the high risk of occult metastasis. For Stage I clinically N0 oral cavity carcinoma, elective neck dissection has been historically recommended for tumor thickness >4 mm but recent evidence supports the effectiveness of elective neck dissection in patients with oral cavity carcinoma >3 mm depth of invasion. The role of sentinel lymph node biopsy in detection of occult cervical lymph node metastasis is promising but requires technical expertise and experience. Identification of biomarkers in predicting the presence of cervical lymph node metastasis may prove to have increasing utility.
