Most decisions for cancer patients are now made on the basis of prognostic and predictive factors. However, due to the limited prognostic value of conventional tumour/nodal/ metastasis staging and histopathological grading in oral cancer, a large group of patients are still over- or under-treated with significant personal and socioeconomical impact. Recent work indicates that morphological and functional characteristics of the invasive tumour front underlie the biological aggressiveness of oral cancer. Incorporation of these concepts into a prognostic system will better reflect the biologic diversity of oral cancer and more accurately predict clinical outcomes and responses to particular types of adjuvant therapy.