Vocal cord leukoplakia, also known as laryngeal keratosis, is a precancerous but benign disease of the larynx. It is related to smoking and drinking, improper use of voice, laryngeal reflux, and genetic factors. It manifests as hoarseness, occasional coughing, and white keratosis-like material on the surface of the vocal folds, some thin and flaky, some scattered and some proliferating significantly and protruding from the surface of the vocal folds. According to its pathological classification, it can be divided into simple squamous epithelial hyperplasia, mild atypical hyperplasia and moderate atypical hyperplasia, and severe atypical hyperplasia. Severe further development will form the possibility of carcinoma in situ or even invasive carcinoma. According to different pathological types, the possibility of malignant transformation is judged. For simple squamous epithelial hyperplasia and mild atypical hyperplasia, they are called benign proliferative lesions and can be treated conservatively first. For moderate atypical hyperplasia and severe atypical hyperplasia, they belong to the risk group and have a high possibility of malignant transformation and can be regarded as precancerous laryngeal lesions. Surgical treatment should be chosen as far as possible. Therefore, vocal cord leukoplakia should be treated according to its different pathological types and lesion scope to decide the treatment.