Colitis-associated carcinoma is often associated with, or preceded by, noninvasive epithelial neoplastic changes termed dysplasia. Surveillance colonoscopy with biopsies looking for dysplasia is now standard practice in the management of the cancer problem in ulcerative colitis. However, this practice continues to have a number of limitations and problems that need to be understood by surgeons who may be referring such patients. A number of recent reports indicate that colitis associated carcinoma is predominantly left-sided and incorporation of this distribution in the surveillance methods merits consideration. The molecular and genetic abnormalities involved in the pathogenesis of colitis associated neoplasia are being actively investigated and may yield supplementary methods to better define individual patient risk.