Gallbladder carcinoma (GBC) often presents at an advanced stage and survival outcomes remain poor, placing increased emphasis on identification and effective treatment for pre-malignant lesions. Gallbladder polyps are the most widely recognized of these lesions. Management of polyps is dependent on four key principles: polyp size, risk factors for GBC, change on serial imaging, and radiographic signs of pseudopolyps. Due to a lack of level one data in the field, expert consensus combining these factors can help surgeons identify appropriate patients for cholecystectomy. Increasing awareness on the progression from pre-malignant to malignant disease has also highlighted two divergent pathways, namely: non-tumoral and tumoral dysplasia. While the former accounts for the majority of cases, the latter represents lesions amenable to radiographic identification and curative intervention. Finally, while porcelain gallbladder is no longer thought of as a ubiquitous precursor for GBC, cases of selective mucosal calcification remain a recognized risk factor for malignant disease. Complete understanding of these lesions is required for all surgeons managing gallbladder disease.