Vocal-fold leukoplakia

B. Microlaryngoscopy with targeted biopsy and preservation of uninvolved vibrating epithelium

Irregular leukoplakia with impaired vibration carries dysplasia or carcinoma risk and requires histology. The biopsy should be diagnostically adequate while limiting avoidable damage to the layered vocal fold.

Why every option is right or wrong

A. Empirical antifungal treatment without follow-up: A suspicious persistent lesion cannot be assumed candidiasis.

B. Microlaryngoscopy with targeted biopsy and preservation of uninvolved vibrating epithelium: Irregular leukoplakia with impaired vibration carries dysplasia or carcinoma risk and requires histology. The biopsy should be diagnostically adequate while limiting avoidable damage to the layered vocal fold.

C. Strip both vocal folds: Bilateral indiscriminate stripping causes scarring and is not justified by a unilateral lesion.

D. Observe for one year: Delay risks progression and later-stage diagnosis.

E. Radiotherapy without tissue diagnosis: Histology is required before oncological treatment unless exceptional circumstances make biopsy unsafe.

What if the scenario changed?

If the lesion were smooth, tiny and vibration preserved in a low-risk patient, short-interval expert surveillance might be discussed, but change would trigger biopsy.