The management of large lip squamous cell carcinoma (SCC) (T2, T3, T4 tumours) or those with nodal disease is well established. However the management of T1N0 tumours is controversial due to the assumed low risk of occult lymph node metastases. This study looked at the prevalence of metastatic lymphadenopathy via a multicentre retrospective analysis of 59 patients treated for T1 lip SCC over a 10 year period in France. Cervical lymph node metastases was found in 11.9% of the cases during follow-up (never at the time of diagnosis), and the mean time for appearance of lymph node metastases was at 13.3 +/- 7.9 months. These results would suggest that the incidence of occult lymph node metastases in T1N0 SCC patients is higher than previously thought, and would suggest that concurrent neck dissection at the time of initial resection of tumour may be recommended in appropriate cases. However, a good quality randomised control trial is required to look at the incidence of lymph node metastases in the T1NO SCC lip group and to determine the impact of this therapeutic procedure on survival.