The potential of exploitation of miRNA as diagnostic agents and therapeutic tools will likely only be realized when a complete knowledge of their biology is revealed. Despite more than a decade of research, the use of miRNA as diagnostic and therapeutic tools remains a 'work in progress'. The objective of this review is to explore more recent developments in the role of deregulated miRNAs in hepatocellular carcinoma (HCC). This includes emerging insights involving miRNA biogenesis, their deregulation by cancer and their role in deregulating the principal HCC cancer pathways. Specific attention is directed at the role of deregulated miRNAs in HCC in a developing country context with high hepatitis B/C burden, as well as an examination of the challenges that confront the use of extracellular miRNAs as commercially viable diagnostic tools to detect early stage HCC.