The anterior commissure has great interest in laryngeal oncology. In its midline there is a higher susceptible to the invasion of cartilage by cancer due to the lack of perichondrium. Larynx cancer can be treated by surgery and radiotherapy and this applies to early tumors involving the anterior commissure. In patients who undergo radiotherapy, a worse rate of local control can be noticed when there is invasion of the anterior commissure. Other therapeutic alternative to early larynx cancer that invades the anterior commissure is open vertical frontolateral laryngectomy which includes part of midline cartilage within the surgical margin, however, in recent decades, it has been replaced by transoral laser procedures. After anatomical, histopathological and imaging review, the different treatment options will be discussed.