Laryngeal carcinoma in situ: a therapeutic dilemma

Two patients having laryngeal carcinoma in situ and seven having carcinoma in situ with microinvasion were treated with laser mucosal dissection of the vocal cords followed by vaporization of adjacent or deeper tissue that appeared abnormal through the operating microscope. In these early cases the depth of vaporization was usually superficial, so the normal architecture of the vocal cords was preserved. Five patients had recurrence or persistence of abnormal tissue; three required one additional laser treatment and two required two additional treatments. After follow-up periods ranging from 18 to 60 months, all patients are presently free of laryngeal abnormalities. No surgical procedures or radiation treatments were required. I believe transoral endoscopic laser treatment of laryngeal carcinoma in situ with or without microinvasion is both feasible and desirable.