To explore whether a single-step diagnosis and treatment of premalignant cervical lesions by the loop electrosurgical excision procedure (LEEP) is appropriate in women at high risk in low-resource countries.Sixty women suspected of having a high-grade lesion on both visual inspection with acetic acid (VIA) and colposcopic examination were randomly allotted to one of 2 groups. In group 1, LEEP was performed immediately and a tissue specimen was sent for histopathologic evaluation; in group 2, a punch biopsy was performed, followed by a histopathologic evaluation; then, LEEP was performed if needed.Among the patients who underwent LEEP, 4 (16%) in group 1 and 3 (15.8%) in group 2 were overtreated. No patients dropped out of the study in group 1 but 5 (20.8%) did in group 2.The single-step diagnosis and LEEP treatment of premalignant cervical lesions is appropriate in low-resource countries.