Central vocal cord leukoplakia and left vocal process granuloma

A vocal over user who speaks publicly several times per week has developed pain on the left side of his neck for the past month. The pain is from the left vocal process ulceration. He quit smoking cigarettes/tobacco almost 10 years ago.

Exophytic leukoplakia of the left vocal cord

He has used tobacco and alcohol and declined a biopsy of the lesion so I am not certain of the pathology. The leukoplakia is very exophytic and reminds me of verrucous keratosis. This could represent squamous cell carcinoma as well.

Vocal cord leukoplakia

Longstanding leukoplakia. Vocal cords are stiff and voice is husky.

Vocal cord leukoplakia in a smoker with false color imaging

51-year-old who has smoked one pack a day for 30 years and consumed significant amount of alcohol is noted a hoarse voice, throat pain and has coughed up some blood.    The slightly raised area on the center of the right vocal cord is very stiff on stroboscopy.

internal laryngocoele

Internal laryngocoele: This mass on the left aryepiglottic fold is an internal laryngocoele. Viewed with false color on a high definition Pentax and the scope  

Cutaneous sarcoidosis

Patient with two years of hoarseness. She has sarcoid of her skin for many years which has been treated with steroid injections. She underwent biopsies of her vocal cords which showed non-caseating granulomas and chronic inflammation consistent with sarcoid.  Operative photos: