The outcome of 123 patients with squamous cell carcinoma of the oral/oropharyngeal mucosa treated by primary radical surgery and simultaneous neck dissection and followed up for a maximum of 5 years is reported and related to the pathological features of the tumour. Actuarial survival analysis showed the overall 1-year survival probability was 84%, falling to 69% at 2 years, and 65% at 5 years. For patients without lymph node metastasis, the corresponding survival probabilities were 95%, 86% and 86%, respectively; and for patients with metastasis, 71%, 52% and 44%, respectively. In all, 30 patients (24%) died of their oral cancer; 16 (13%) of local recurrence, 10 (8%) of regional recurrence and 4 (3%) of systemic metastases. In addition to lymph node metastasis, survival was related to the site and stage of the primary tumour, histological pattern of invasion, status of the resection margins and, for patients with metastasis, the number and anatomical level of positive nodes and the presence and extent of extracapsular spread. These pathological features are important indicators of tumour behaviour and should be incorporated into protocols for assessment of prognosis.