How serious is a fatty liver with a lesion on it? husband had this for almost 2 yrs now. not being treated. he is a heavy smoker and no alcohol usage.

Depends : The answer mostly depends on what the lesion is.I would recommend that he consider trying to lose weight and to return to his physician to learn more about what the apparent lesion is. If his physician does not know, further tests may be necessary. Good luck.

Hard to say: Hi. We really can't say. Fatty liver can be associated with cirrhosis, which increases liver cancer risk. The liver is a common site of metastases from elsewhere (e.g., lung cancer in a smoker). The liver lesion may be any number of benign conditions. I suggest he see a gastroenterologist. A needle core biopsy of the lesion may be indicated. Good luck!