The concept of epithelial atrophy in oral submucous fibrosis (OSF) is based on the assumption of an ischemic epithelium consequent to poorly vascularized stroma, but the role of vascularity on the epithelial thickness in OSF is not clearly understood. This study aimed to investigate the immunohistochemical expression of CD34, for characterization and quantification of mucosal vasculature and its possible role in malignant transformation of atrophic epithelium in oral submucous fibrosis. After compilation of available data, the present study challenges the conventionally believed concept that epithelial atrophy in OSF is due to lack of perfusion, caused by decreased vascularity of subjacent connective tissue stroma. Characteristic pattern of juxtaepithelial loss of CD34 positive stromal cells and its role in malignant transformation in OSF deserves further attention.