A number of changes occur in preneoplastic and neoplastic cells as they progress towards a greater degree of malignancy. These alterations include genetic changes, epigenetic changes, surface alterations and alterations in intercellular interactions. In some instances, these changes are contributing factors to the degree of pathology noted, whilst others are resultant. In many situations, the relationship between these changes and the progression towards neoplasia is not understood. Nevertheless, it seems probable that these changes are ultimately involved in driving cells further along the path to neoplastic transformation. It is the purpose of this review to consider the changes which occur as cells progress from normality to being neoplastic, with particular reference to the cells of the oral mucosa, and the use to which detectable changes can be used as prognostic indicators.