The finding of a white patch on the laryngeal mucosa may herald the inset of malignancy or may be of absolutely no clinical significance. The challenge is to evaluate its importance and treat what may be a completely benign process without compromising laryngeal function. There is a wide spectrum of potentially pre-neoplastic processes for which management is controversial. A careful follow up is mandatory, but patient compliance may be lacking. (Singh et al 2019).
A 65yr/M presents with the chief complaint of change in his voice for one year. It is of gradual onset, slowly progressive, and continuous, without relieving or aggravating factors. There is no difficulty in breathing or swallowing. There is no history of neck pain, neck swelling, laryngopharyngeal reflux, weight loss, bronchial asthma or any major illness in the past. He is a farmer by occupation, without history of vocal abuse. He smoked 5 to 10 cigarettes per day for 30 years. He does not consume alcohol or chew tobacco. There is no known allergy to any food or drug. There is no history of intake of any systemic or inhalational steroid.
Endoscopic examination shows a bilateral lesion involving at least the anterior one third of both vocal cords and anterior commissure. Both cords are mobile and the white lesions cannot be scraped off the mucosa.
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