BACKGROUNDWhite lesions in the oral cavity may be benign, pre-malignant or malignant. In India, oral cancer ranks first among all cancers in males and third among females. The five-year survival in oral cancer is directly related to the stage at diagnosis.The aim of this study was to investigate the various clinical and histological patterns of keratotic white lesions of oral mucosa and early detection of malignant changes to avert life threatening complications.