Dysplasia at the margins of laryngeal cancer specimens following laser resection – is conservative management appropriate?
Reviewed by Christopher Burgess

Transoral laser microsurgery (TOLM) remains the cornerstone of treatment for early laryngeal squamous cell carcinomas. Whilst the hope is always to achieve a complete surgical excision with clear margins, it is sometimes the case that on histological analysis, disease is identified extending to the edge of resection. This can take form of either frank carcinoma or dysplasia not amounting to carcinoma. In this paper, the authors reviewed a cohort of 281 patients treated for laryngeal SCC with TOLM over 20 years with cancer-free margins at the time of initial resection. The cohort was divided into a group for whom completely clear margins were obtained and a group in whom dysplasia was identified at the margin of resection. In total, 217 patients (77%) were found to have clear margins whilst dysplasia was identified in the margins of 64 patients (23%). The dysplasia was graded as LIN 1 in nine patients (14%) and LIN 2 in 55 patients (86%). Dysplasia at the resection margins was found in this cohort of patients not to correlate with worse overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS), irrespective of severity. Five-year OS, DFS and DSS were 92%, 85% and 99% respectively. Given these findings, the authors conclude that revision surgery for critical dysplastic margins following TOLM for laryngeal carcinomas should not be performed. Instead, it is recommended that patients are monitored endoscopically in the clinic in order to minimise the potential for overtreatment and consequent negative effects on voice outcomes. Assuming this is how this cohort was managed, the data presented would certainly seem to support this approach.

The real prognostic role of laryngeal dysplasia in patients affected by invasive cancer.
Chu F, Bandi F, Pietrobon G, et al.
AM J OTOLARYNGOL
2025;46(1):104535.