Various treatment modalities have been described for reducing or eliminating malignant development of oral leukoplakia, but no treatment has gained universal approval due to lack of randomized clinical studies. At present, it is uncertain whether we can do harm to the patients by treating or by not treating them. An essential aspect is the observation of cancer development even after surgical removal of the clinical lesions. Inadequate resection of the lesions or field cancerization may account for this phenomenon. Another challenge is whether surgical removal of the lesions in fact is associated with a cancer promotional effect resulting in increased risk of cancer. Moreover, unidentified existing cancer in non-suspicious oral leukoplakias may for diagnostic purposes imply that surgical removal is recommendable as well as serial section of all excised tissue. Intensive follow-up programmes for leukoplakias are important, independent of surgical intervention.