Palm oil mill effluent (POME) continues to pose a significant environmental threat across palm oilproducing regions due to its high organic load, persistent colour, and the presence of heavy metals and nutrients that often exceed regulatory discharge limits. This review synthesises findings from peer-reviewed studies published and indexed in the Scopus database between 2010 and 2025, focusing on the application of activated carbon (AC) for POME treatment. The reported removal efficiencies for key pollutants ranged from 55.00%–95.00% for chemical oxygen demand (COD), 60.00%–96.00% for biochemical oxygen demand (BOD), and up to 99.43% for colour, depending on the source material, surface area, and operating conditions. AC derived from agro-industrial wastes such as palm kernel shell (PKS), empty fruit bunches (EFB), rice husks, and sludge achieved surface areas up to 935 m²/g. Adsorption was primarily governed by surface complexation, ion exchange, and Van der Waals interactions. Process optimisation via response surface methodology (RSM) identified pH (3–10), adsorbent dosage (5–125 g/L), and contact time (30–240 min) as key variables. Thermal regeneration restored up to 94.00% of AC performance. The novelty of this review lies in its integrated approach combining pollutant-specific adsorption analysis, adsorption mechanisms, biomass-based AC synthesis, statistical process optimisation, and regeneration strategies-consolidating fragmented literature into a comprehensive resource. This review further outlines knowledge gaps and offers strategic recommendations for implementing low-cost, sustainable AC-based treatment technologies tailored for POME remediation.