The appropriate treatment of high grade squamous lesions and careful post treatment follow-up is pivotal in reducing the incidence and mortality from cervical cancer. Women with suspected high grade dysplasia should have a colposcopy and directed biopsy prior to excisional or ablative treatment unless a diagnostic excision is planned. Excisional treatments with the exception of cone biopsy should be performed under colposcopic guidance. While loop excisional treatment and laser ablation are equally effective in the treatment of squamous dysplasia, surgeon skill/training, type of transformation zone, presence of vaginal disease, previous treatment and possibility of underlying micro-invasive disease will determine the best modality of treatment for each patient. Patients undergoing laser ablative therapy should have biopsy proven disease, no colposcopic suspicion of high grade dysplasia and a fully visualized lesion. Patients with biopsy proven high-grade disease, no suspicion of invasive cancer and co-existant vaginal disease are ideal candidates for laser ablation. Excisional therapy is preferred in patients with failed previous ablative treatment, colposcopic suspicion of micro-invasive cancer, and incompletely visualized lesions. Treatment is best carried out to a depth of 6-8mm in cases of well visualized high grade dysplasia but may need to be deeper and tailored to the geography of the lesion in patients with a type 3 transformation zone.