Aggressive Tumor, Aggressive Treatment

Although the patient (1) has undergone an in-office endoscopy, we would specifically advocate for a direct laryngoscopy under general anesthesia with biopsies of the ipsilateral base of tongue and tonsillectomy. If no primary site were identified, we agree this neck mass likely represents cutaneous metastasis given the positive p16 immunostain (2), negative human papillomavirus in situ hybridization status, and overall clinical picture.

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