Introduction: The oral cavity is susceptible to trauma and injury leading to various diseases that range from simple inflammatory lesions to highly malignant tumors.Smoking is the most threateningrisk factor and the most prevalent lesions are well differentiated squamous cell carcinomas. Aim: To identify the morphological spectrum of oral lesions in urban areas like Visakhapatnam in correlation with specific risk factors and categorize them according to age, gender and site. Materials and Methods: This is a retrospective cohort study conducted at the Department of Pathology in association with the Department of ENT at GayatriVidya Parishad Institute of Health Sciences, Andhra Pradeshwhich included 220cases of oral lesions from January 2022 to February 2024.Frequency and percentage statistics were used to present the results. Results: A total of 220 oral cavity lesions were included in the present study, out of which 26 were non-neoplastic. Among the 194 neoplastic lesions, 40 were benign, 26 were pre-malignant and the rest 128 were malignant lesions. The age group ranged from 10-85 years with majority of patients with malignant lesions found in the 4th and 5th decades of life. A male preponderance with a male-to-female ratio of 1.5:1 was observed. Gingivo-buccal mucosa was predominantly involved (39.9%) followed by tongue (18.8%) and palate (11.81%). Ulceroproliferative growth was the most common clinical finding in malignant cases. Conclusion: Oral lesions and cancers are the most common health burdens in developing countries. The incidence of oral SCC remains high due to habits like tobacco chewing and alcohol consumption in the Visakhapatnam region.