Colposcopic features of cervical adenocarcinoma in situ (AIS) and adenocarcinoma exist, and colposcopists can learn to recognize them. This ability will increase the colposcopic discovery rate for these lesions and can lead to appropriate management in early stages. An excisional biopsy with negative margins is required to differentiate between in situ and invasive disease. The general categories of revealing features are surface patterns and blood vessels. Surface patterns indicative of AIS and adenocarcinoma are (1) lesions overlying columnar epithelium not contiguous with the squamocolumnar border; (2) lesions with large “gland”/cleft openings; (3) papillary lesions; (4) lesion exhibiting epithelial budding; and (5) variegated red and white lesions. Blood vessels indicative of AIS or adenocarcinoma are (1) waste-thread-like vessels; (2) tendril-like vessels; (3) rootlike vessels; (4) character-writing-like vessels; and (5) single and multiple dotlike formations in tips of papillary excrescences. Some of these characteristics also are apparent when other disease processes are present, but an observant colposcopist can differentiate lesions using inclusionary and exclusionary criteria.