Patients with ulcerative colitis and colonic Crohn’s disease are at an increased risk of developing colorectal malignancy. The reporting of such cases in the literature has led to the identification of a number of risk factors for the development of mucosal dysplasia and cancer. The diagnosis of dysplasia and the subsequent management, however, are not without controversy, as is the practice of surveillance colonoscopy that is commonly performed in an attempt to reduce the risk of cancer.