Most oral cancers do not arise in a clinically identified oral potentially malignant disorder and are diagnosed as primary cancerous lesions. They are typically painless, unless infected or advanced, and often cause no symptoms. For this reason, the need to conduct a careful systematic examination for every patient cannot be stressed too much. Extra-oral exami­nation should include both visual inspection of the face and neck and palpation of the neck (see Chapters 2 and 16). The patient’s head should be tilted forwards and the lymph nodes in the neck palpated in relaxed tissue. A routine technique should be adopted, perhaps starting with the submental nodes and then moving to more posterior node groups. The oral mucosa and oropharynx should be examined carefully. The tongue should be protruded to detect lateral deviation and then relaxed and lifted to allow examination of its ven­tral surface and the floor of the mouth. Correct positioning and the use of good illumination and mirrors are important factors. When oral cancer is detected, prompt referral is es­sential. The importance of attending at the hospital should be stressed, without provoking undue anxiety. Until a biopsy result is available, providing a definitive diagnosis should be avoided. Any ulcer that fails to heal within a 3-week period should be regarded as suspicious, and the patient should be referred to a specialist.