**4.5 Follow up**

The follow up of such patients is the most vital part of their management since there is always a risk of recurrence and malignant transformation. In the literature no fixed protocol has been designed for the follow up plan of premalignant lesions but it has been noted that malignant transformation rate is higher with moderate to severe dysplasia as compared to mild dysplasia [15]. To simplify things we follow a self-designed protocol according to which we divide the patients into two groups that is the high risk and low risk group. Now patients in high risk group are those who have moderate, severe dysplasia and carcinoma in situ (according to WHO classification) and patients even with mild dysplasia but who are cigarette smokers, heavy alcohol consumers are included in this group. In high risk we follow the same protocol as T1 carcinoma that is for initial 2 years every month follow up, 2 monthly in the second year, 3 monthly in the third year and 6 monthly in fourth and fifth year.

In cases of low risk group the follow up plan was to do a regular monthly check up for at least 6 months. Following that clear instructions to the patient to revert back, if there is change in voice and on appearance of any suspicious symptoms.
