Current concepts of endoscopic management of supraglottic cancer are an extension of precepts fostered by Jackson. The current approach has been facilitated by a half century of technological developments: the surgical microscope, the CO2 laser, improved laryngoscopes, and general endotracheal anesthesia. Selected small-volume cancers can be curatively resected, whereas excisional biopsy can be performed on larger neoplasms. With this cost effective minimally-invasive surgical approach, there is less disturbance of normal tissue, thereby minimizing morbidity rate and hospitalization. If the transoral excision is inadequate, radiotherapy can not be depended on to eradicate known residual disease. Endoscopic resection of supraglottic cancer should not alter the surgeon's standard management of the neck.