The development of hepatocellular carcinoma entails a multistep pathogenic process. Intermediary premalignant lesions, namely dysplastic foci, dysplastic nodules (divided into low-grade and high-grade dysplastic nodules), and hepatic adenomas, are often implicated in the process. Dysplastic foci and nodules display histologic alterations in the form of large cell change or small cell change. Small cell change and high-grade dysplastic nodules are more commonly associated with an increased risk of progression to hepatocellular carcinoma. Certain features on histopathology and radiology may clarify the differentiation of premalignant lesions from hepatocellular carcinoma, although this could be more challenging in the case of dysplastic lesions. The degree of malignant potential guides the management of these lesions, which ranges from active surveillance to surgical intervention.