Objective: Laryngeal melanosis (LM) has been defined as the pigmentation of the basement membrane of the laryngeal mucosa, and although it is associated with smoking, its relationship with malignancy has not been conclusively proven. Our aim in this study is to contribute to the literature of the presence of malignant and premalignant lesions with LM and to discuss the necessity of direct laryngoscopy (DL) in patients with suspected LM. Material and Methods: Patients having a histopathological result as LM after DL between 2010-2020 in Ankara University Medical School Department of Otorhinolaryngology were reviewed retrospectively. Results: A total of 6 patients, 5 (83.3%) male and 1 (17.7%) female, were included in the study and their mean age was 62 (±13). All patients had a history of tobacco use. Histopathological examinations revealed low-grade dysplasia in 3 (50%) patients, and hyperkeratosis in the other patients. The mean follow-up was 60.6 months (18-120) and no malignancy was detected. Upon repeating histopathological examination in 4 (66.6%) patients, 2 patients were found to have low-grade dysplasia, while the other two patients had hyperkeratosis. Conclusion: Although whether or not LM gives rise to squamous cell carcinoma is not well-known yet, long-term follow-up of LM patients is important in detecting coexistence of premalignant lesions. Since LM is a rare disease, we recommend that direct laryngoscopic (DL) examinations should be performed in symptomatic patients, and the decision to perform DL in asymptomatic patients should be made by evaluating the risk factors in the development of laryngeal cancer.