Background: miRNA profiling across different stages of laryngeal carcinogenesis explores dysregulated molecules relevant to engaged gene pathways and identifies markers for differential diagnosis and prognosis in early mucosal lesions of the larynx. Methods: Tissue samples were prospectively collected from 28 patients with hypertrophic vocal fold lesions: no dysplasia (ND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and invasive cancer (IC), as well as from 3 patients with vocal fold polyps. miRNA profiling of the samples was performed using microfluidic cards—TaqMan^® Human MicroRNA Array A. A comparative analysis of ΔCt (dCt) miRNA expression levels was conducted between groups. Results: hsa-miR-216a-5p and hsa-miR-488-3p were selectively expressed in control tissues, while hsa-miR-105-5p and hsa-miR-516a-5p were exclusively detected in HGD and IC samples. Significant differences in miRNA expression were identified across 4, 16, 17, and 38 miRNA types between control and ND, LGD, HGD, and IC groups, respectively. hsa-miR-185-5p and hsa-miR-21-5p showed significantly altered expression between ND and LGD, HGD, and IC (p = 0.026, 0.001, 0.002; and p = 0.021, 0.002, 0.001, respectively). Twenty-five miRNAs were differentially expressed between LGD and both HGD and IC, while eleven miRNAs distinguished HGD from IC. Notably, hsa-miR-503-5p expression decreased progressively with increasing histological severity. Conclusions: Distinct miRNA expression profiles are associated with progressive stages of laryngeal mucosal lesions. Specific miRNAs may serve as valuable biomarkers for early detection, risk stratification, and prognosis in vocal fold carcinogenesis.