Premalignant lesions of the laryngeal epithelium most commonly involve the glottis. Abnormal appearing mucosal lesions may warrant biopsy for histologic review before an assessment can be made regarding their risk for malignant transformation. Although higher degrees of dysplasia portend a greater chance for malignant transformation, findings of dysplasia or carcinoma in situ should prompt ablative therapy followed by surveillance for recurrence or progression. Risk factor modification remains important not only as a primary prevention strategy, but also to reduce the risk of progression to invasive carcinoma. We review the current evidence pertaining to the work-up and management of premalignant epithelial lesions of the larynx. Surgical excision continues to be the treatment of choice. Alternative therapies like photodynamic therapy and radiation may be employed in selected patients when surgical therapy is not the best option.