Many otolaryngologists performed microsurgery of the larynx for white or red lesion of the larynx. These lesions of uncertain behavior can be challenging both in establishing the diagnosis as well as preserving function. Furthermore, recurrent lesions on the larynx after initial treatment are a common problem. Taking these patients back for repeat his surgery because of suspicion of neoplasia is neither efficient nor safe. This session will highlight the approach of the senior author in the investigation and management of lesions of uncertain behavior. The presenters will a) highlight the role of preoperative imaging including videostroboscopy and narrow band imaging; b) present equipment and surgical techniques during surgery to optimize success in the diagnosis and management of these lesions; c) emphasize the role of definitive treatment for lesions of uncertain behavior; d) show video presentation of excision of leukoplakia by micro-flap technique; e) discuss the role of Lasers; and e) discussed office management of lesions of uncertain behavior using office based KTP laser and photodynamic therapy. This case-based session will focus on diagnosis and management of: a) reactive keratosis; b) mild dysplasia; c) carcinoma in situ; and d) micro-invasive carcinoma of the larynx. Learning Objectives: 1.Describe the role of video-laryngoscopy, videostroboscopy and narrow band imaging in evaluation of surface lesions of the vocal fold prior to planned operative micro-laryngoscopy. 2. Maximize the operating diagnostic micro-laryngoscopy procedure to successfully achieve a definitive diagnosis while preserving vocal function by using a micro-flap phono-surgery technique. 3. Apply modern office treatment techniques including office KTP, office biopsy and photodynamic therapy to manage lesions of the vocal fold without repeated return to surgery. Faculty: Peak Woo, MD(Nothing to disclose).