Team time out and induction of anesthesia by the anesthesia colleagues with intubation. Dental status determined. Insertion of the Mc Ivor oral spatula and exposure of the right oropharynx: A slightly rough, spherical protrusion with smooth mucosa, approx. 0.8 cm in diameter, can be seen in the area of the former ablation on the anterior right palatal arch. Laterocaudally, the alveolar ridge is somewhat exposed after previous surgery. In addition, there is a leukoplakia on the right posterior palatal arch, which was not present 4 weeks ago, measuring approx. 3 x 6 mm longitudinally oval. No other new mucosal abnormalities in the rest of the oropharynx. Infiltration of the anterior and posterior right palatal arch with local anesthesia, Ultracaine 2% with the addition of Suprarenin. Now excision biopsy of the leukoplakia on the right posterior palatal arch with a 5 mm safety margin using a scalpel and pointed scissors. Suture marking still in the surgical site at 12 o'clock (cranial) and at 9 o'clock (lateral). The frozen section examination according to the telephone announcement by the pathologists shows a 2 cm large carcinoma in situ in the resectate, whereby a marginal formation in the frozen section at 12 o'clock cannot be ruled out, thus recommendation for subsequent resection, which takes place later. First, the already planned resection on the anterior palatal arch on the right: with a safety margin of approx. 5 mm, the raised, rough mass is cut around with the scalpel and pointed scissors on a smooth mucosal surface. Here too, suture marking in the surgical site at 6 o'clock (caudal) and 9 o'clock (lateral). The required size of the resection results in a defect in the anterior palatal arch, which is later adapted. According to the pathology department, the frozen section examination shows an invasive carcinoma of 0.2 cm originating from the CIS, which forms the cranial margin and also a moderate degree of dysplasia laterally, whereby it cannot be clearly distinguished from the CIS in the frozen section. Therefore recommendation for resection here as well. Preoperative demonstration to the previous surgeon <CLINICIAN_NAME>. Now case discussion with <CLINICIAN_NAME>, also based on the tumor conference decision, see file. Now indication for subsequent resection at the above-mentioned sites in accordance with the pathological recommendation, this time for definitive histology as well as an additional biopsy on the left anterior palatal arch in macroscopically unremarkable conditions to clarify whether a carcinoma in situ is also present here in the current case of field carcinomatization. Then discussion at the tumor conference and no PEG placement today. Now follow-up resections: Posterior palatal arch on the right: cranial resection of an approx. 5 mm wide strip of mucosa using a scalpel and pointed scissors. This is marked with sutures in the operating theater, both medially and cranially. Send in for definitive histology. Right anterior palatal arch resection: resection of a 5 mm wide strip of mucosa using a scalpel and pointed scissors, covering the entire area from medial to cranial to laterocaudal, triple suture markings. Sketch/photo with all markings see file. Finally, the right anterior palatal arch is adapted into the wound bed with Vicryl 4-0. No bleeding. In addition, biopsy of the left anterior palatal arch. No bleeding. Finally, insertion of a nasogastric feeding tube due to the extensive resection defect in the right oropharynx. Position control under direct vision and auscultatory with air insufflation. The procedure was completed without complications. Conclusion: Post-resection of the anterior right palatal arch for invasive squamous cell carcinoma originating from a carcinoma in situ and excisional biopsy of the posterior right palatal arch for carcinoma in situ; frozen section control. An additional resection of both sites was performed and will be followed by definitive histology. In case of suspected field carcinoma, biopsy of the left anterior palatal arch in a pale mucosal area. Procedure: Discussion in the tumor conference of the definitive histologies of the frozen section and the post-resectates. A PEG was deliberately avoided (see above). A PEG should only be inserted if radiochemotherapy is definitely indicated. Nasogastric tube in the right oropharynx for 3-5 days depending on the findings.