Soon after leaving the city, the highway begins to follow the North Fork of the Nehalem River (and several minor tributaries).

It follows this river for a distance, until the highway ends at an intersection with U.S. Route 26 at Necanicum Junction.

OR 53 is a narrow, winding roadway for most of its length, and primarily serves local and recreational traffic.

Service to Cannon Beach, Arch Cape, and Manzanita were previously by discontinuous local roads.

Milepoints are as reported by ODOT and do not necessarily reflect current mileage.