A man in his 60s presented with a 6-month history of dysphagia, a 3-month history of a 2.268-kg weight loss (to convert to pounds, divide by 0.454), and a right neck mass. Tobacco history was minimal and distant, and alcohol use was social only. Physical examination, including flexible nasolaryngoscopy, was notable for a large smooth nonulcerated right base of tongue mass with almost complete pharyngeal airway obstruction, and a 4-cm right level II lymph node. Computed tomography (CT) imaging revealed a 3-cm base of tongue–lingual tonsil mass with multiple right Ib, IIa, and II/III nodes, the largest of which was 2.0 cm by 3.0 cm. Awake tracheotomy and direct laryngoscopy with biopsy of right base of tongue mass lesion was performed.