An 80-year-old male presented with a 3-month history of hoarseness. He had been a heavy cigarette smoker for 40 years, and 5 years earlier, a laryngeal biopsy had shown hyperplasia of the squamous epithelium, with no evidence of dysplasia. Flexible fiber-optic laryngoscopy demonstrated a keratotic vegetating lesion involving both vocal cords and the anterior commissure. Clinical examination revealed adenopathy in neck level III on the right side. A CT scan was performed, revealing a glottic neoplasm involving both true vocal cords and the anterior commissure, without invasion of the posterior commissure (Figure 1). The lesion apparently involved the right false vocal cord in the coronal plane, but no invasion of the paraglottic spaces, thyroid, and arytenoid cartilages was evident. Cervical lymphadenopathy with cystic appearance was detected in level III of the right lateral cervical chain in the MRI imaging (Figure 2). The patient underwent total laryngectomy with bilateral neck dissection.