Exophytic leukoplakia of one vocal cord

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Exophytic leukoplakia of the left vocal cord

Exophytic leukoplakia of the left vocal cord with filtered lighting

Exophytic leukoplakia of the left vocal cord during stroboscopy

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.