Background: Variation in oncologic decision-making can affect outcomes in oral cavity cancer. We hypothesize that such variation would exist across the specialties of General Surgery (GS), ENT, Oral Maxillofacial surgeons (OMFS), Head and Neck Surgery (HNS), and Surgical Oncology (SO) and that a formal structured fellowship training in Head and neck oncology would be associated with closer adherence to guideline-based care. Methods: Cross-sectional online survey of multiple specialty surgeons done. Descriptive analysis, Kruskal–Wallis, Mann–Whitney U, Fisher’s exact, and Chi-square tests were applied (p<0.05). Results: A cohort of 75 respondents representing diverse surgical specialties. Overall, 16.0% violated neck management guidelines for cT1–2N0 oral tongue cancer, 21.3% targeted suboptimal margins (<5mm), and 17.3% applied non-standard adjuvant referral criteria. No SO/HNS surgeon targeted suboptimal margins, versus 52.9% of General Surgery (χ²=21.85, p<0.0001). Fellowship training eliminated suboptimal margin targeting (Fisher's p=0.031). The composite violation score differed significantly by specialty (Kruskal-Wallis H=22.30, p<0.0001): SO/HNS mean 0.13 (90% zero violations), OMFS 0.24 (88% zero), General Surgery 1.12 (29% zero; vs SO/HNS p<0.0001; vs OMFS p=0.0014). Non-standard adjuvant referral varied by specialty (χ²=6.93, p=0.031). Critically, 10.7% targeted guideline-compliant margins but lacked intraoperative frozen section access — a structural quality gap independent of surgeon intent. Conclusion: Oncologic decision-making varies by specialty and surgical training background in India. Fellowship training aligns with improved adherence across domains, while resource constraints continue to influence care in a subset of settings.