Just a quick comment while I am at MDACC and am really tight for time. 28% of all stage one and two SCC's have occult mets to the cervical nodes of the neck. For this reason at many major cancer centers, even early stage lesions get limited radiation to the neck nodes, a known route of mets, and/or a neck dissection to ensure that those areas are free from malignancy. Gary is part right, there are occult oral cancers, or even cancers in general where we see the cancer first in an area of metastasis, but there is poor indication of where the primary is. But in surgical only solutions to oral SCC's, occult mets are the biggest problem. Surgeons who claim that they "got it all with clean margins" are doing a disservice to patients if they do not refer that patient to a radiation oncologist that they interface with. It is a big decision for both the patient and the doctors to decide if you are one of those one-in-four individuals in which an original micro met, which is not detectable through a CT or MRI, is something they should chase and deal with. Having an unclean margin is certainly not something that I personally would want to live with. That is not going to go away on its own, and needs to be dealt with. But this issue that anything that appears a year later is a recurrence is BS. One quarter of those are the original disease that was not dealt with completely the first time around. Then you have the issue of secondary primaries, which would include a recurrence in a site distant from the original tumor