Occult colorectal cancer (CRC) has historically driven recommendations for colectomy in patients with inflammatory bowel disease with dysplasia . We defined the contemporary risk of occult CRC at colectomy among 93 patients with inflammatory bowel disease with dysplasia based on endoscopic appearance, resection, and concordance between site of cancer at colectomy and dysplasia at colonoscopy. Contrary to our hypothesis, we found that occult CRC at colectomy remains elevated in high-grade polypoid and invisible dysplasia. It was infrequent in other visible lesions. When present, occult cancer occurred in the same segment as dysplasia, suggesting the historic concern of missing a remote cancer is low.