The evolution of the surface microstructure of sputtered c-axis oriented epitaxial YBa2Cu3O7-δ films has been monitored by scanning tunneling microscopy (STM). The results indicate that growth is dominated by the incorporation of depositing species at defect sites. These defect sites, which provide energetically favorable positions for accommodating the arriving species, are at ledges—either along growth spirals emanating from screw dislocations, or due to the closely spaced surface steps arising from the macroscopic tilt of the substrate. If the substrate is misoriented sufficiently, the depositing species may diffuse to and be accommodated by these surface steps, without the supersaturation on the terraces attaining a high enough level for two-dimensional nucleation to occur. Under these conditions, growth occurs by step propagation. Otherwise, a high density of screw dislocations (≈109 cm-2) is nucleated during the initial stages of growth, which provides a continual supply of ledge incorporation sites in the vicinity of the depositing species. The surface evolution reported appears to be an intrinsic feature of c-axis oriented YBa2Cu3O7-δ films for a wide range of growth conditions, irrespective of the substrate material or vapor phase deposition method.