Despite advances in oncology, primary hepatic malignancies, mainly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) remain a diagnostic and therapeutic challenge. The rule is late diagnosis when surgical treatment, which is the only option for definite therapy, is not efficient in terms of radicality and sometimes not technically feasible. Alternative or complementary modalities such as chemotherapy, transarterial catheter embolisation (TACE), radio-frequency ablation (RFA), have failed to demonstrate satisfactory results. These malignancies also tend to recur after curative resection. These data demonstrate the obvious need for the establishment of novel diagnostic and therapeutic modalities in order to optimize the curative result. MicroRNAs have been in the frontline of research in the last years, since it has been discovered that they regulate a major spectrum of cellular functions in health and disease. In particular, their role in oncogenesis and specifically hepatocarcinogenesis has been investigated with promising data for further applications in the fields of diagnosis and treatment.