Fifteen years earlier, a 63-year-old white man with no significant medical history and no tobacco, alcohol, or radiation exposure presented with a 3-month history of hoarseness. He was noted to have a subglottic mass and underwent direct laryngoscopy and biopsy, with pathologic findings that were similar to those shown in Figure 1 and Figure 2. He also underwent conservative excision of the lesion and had no evidence of disease until 10 years after the initial procedure. Direct laryngoscopy and a biopsy were performed at that time, and the findings were consistent with a recurrence of the lesion. The patient underwent a second conservative excision, which, similar to the initial procedure, consisted of a tracheotomy, a laryngofissure, and excision of the mass as well as the inner table of the cricoid cartilage. Two years later, in 2000, he again presented with hoarseness, and a computed tomographic scan was obtained (Figure 3). He then underwent a total laryngectomy for definitive control of the lesion. The gross specimen is shown in Figure 4.