Background: Oral squamous cell carcinoma in the background of oral submucous fibrosis (OSCC with OSMF) is one of the most common malignancies in South and South-East Asian countries. The clinical presentation of OSCC is variable, and is related with the site , progression time, association with precancerous lesions and risk factors. Recently, it has been proposed that OSCC with OSMF constitutes a clinicopathologically distinct disease, the differences of which believed to arise from differential mechanisms of areca nut carcinogenesis. The proposed unique nature of OSCC in this altered condition relates to younger age of presentation, better histological grade of differentiation of the tumor, and lesser potential for nodal metastasis. According to the existing knowledge, the prognostic indicators of OSCC with OSMF in context to the clinical presentation of the lesion have not been thoroughly investigated. With this premise in mind this research is designed to provide the basis of clinical presentation of OSCC with OSMF with its early detection and better grade of tumor differentiation. Objectives: 1. To assess the clinical presentation in OSCC and OSCC associated with OSMF. 2. To assess the correlation of clinical presentation with clinicopathological features in OSCC and OSCC associated with OSMF. 3. To assess the correlation of clinical presentation with prognosis in OSCC and OSCC associated with OSMF. Methodology: The data of three hundred twenty clinically and histopathologically diagnosed, surgically operated cases of OSCC were included in the study. Further on the basis of association of OSMF, the OSCC patients were sub grouped into two. Group one includes OSCC without OSMF (166 cases) and group two OSCC associated with OSMF (154 cases). Demographic data and follow-up information for disease free survival of five years was documented in the records. Further detailed information in perspective to clinical presentation of the lesion was recorded. Expected Results: Considering the differential mechanisms of areca nut carcinogenesis in OSCC associated with OSMF, there will be variation in clinical presentations from erythroplakic, erythroleukoplakic, ulcerative/endophytic ulceroproliferative to proliferative/exophytic amongst OSCC without OSMF and OSCC associated with OSMF cases. Conclusion: The clinical presentations in OSCC associated with OSMF will be supportive of the already suggested unique characteristics with good clinicopathologic profile and better prognosis and oncological outcomes.