Objective: Early detection and treatment in patients with esophageal cancer is the most effective way to improve the prognosis. Patients with high-grade dysplasia (HGD) in esophageal mucosa might be involved with early esophageal cancer, but the management of the disease is controversial. The purpose of our study was to explore the management of esophageal mucosa with HGD. Methods: We retrospectively analyzed 10 patients with HGD in esophageal mucosa, who underwent esophagectomy in Cancer Hospital of Fudan University from 1999 to 2006. The surgical approach, postoperative morbidity, in-hospital complications and pathological results of the patients were analyzed. Basing on our data together with other studies, we aimed at looking for an appropriate management for patients with HGD. Results: Of the 10 patients who received esophagectomy, the pathological results showed that 2 (20%) cases were in situ carcinoma and 8 (80%) cases were invasive cancer with no regional lymph nodes involved. 30-day mortality was 0. One patient experienced cervical anastomotic leakage, but healed in 2 weeks. There was no pulmonary complication. Conclusion: Most patients with HGD actually have occult carcinoma. High percentage of patients with HGD would develop into cancer during their lifetime. Esophagectomy is now a selective approach for the treatment of the patients with HGD.