A 55-year-old male smoker presents with progressive hoarseness. Laryngoscopy reveals a whitish lesion covering the entire right vocal cord. Biopsy shows moderate dysplasia (CIN II equivalent). The most appropriate management is:

• A Observation with repeat laryngoscopy in 3 months
• B Cessation of smoking and voice therapy alone
• C Total laryngectomy with neck dissection
• D Microlaryngoscopic excision with CO2 laser stripping ✓

Explanation

Moderate laryngeal dysplasia (CIN II equivalent) carries a significant risk of progression to invasive carcinoma and requires active treatment. Microlaryngoscopic excision using CO2 laser or cold steel with vocal cord stripping provides histological clearance, allows accurate staging and treats the pre-invasive lesion. Observation alone is inadequate for moderate or severe dysplasia. Voice therapy and smoking cessation may supplement but cannot replace surgical excision at this grade. Total laryngectomy is excessive for pre-invasive disease.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.