It's hard for those of us here to really give you advice on this. Many ENT's are head and neck surgeons that see oral caners routinely. I think what bothers me is that your first go around with this, someone "looked" at your tongue and told you it was HPV. I don't know how that could be done. LIchen planus is a flat white lesion like leukoplakia, but from a different etiology. HPV is a virus, not something that you could actually see in your mouth. Sometimes people develop little raised areas in their mouth like buds, or flame shaped growths, these can be from an HPV infection. But at the end of the day, you can't know that it is HPV caused without a surgical biopsy because there isn't anything to see related to the virus. You can certainly see the white leucoplakia patches. I'm just not fond of people thinking that they can look at something and tell you what it is, I don't care how experienced they are. Only a pathologist looking at a cell sample under a microscope can tell for sure, anything else is a guess. Did someone do a pathology report on the other growth you had taken off? Not all HPV that cause growths also cause cancer, so I would have bee good to know out of 130+ versions of it, what HPV was involved in those growths if they were actually HPV caused at all.

Anyway, taking it off needs to be done, with the new biopsy report that you have showing that is beyond the dysplasia stage, and a laser for taking of the large portion of the white patch that is only moderately involved is a good way to do that, because the laser can just burn off the superficial cells The area will be sore for a few days but since it is so shallow, there won't be any stitches or anything, it will just heal in by what they call secondary intent.

If this doctor is really experienced in oral cancers, it is certainly not a bad thing to have him remove this. But most of the posters here have not had these very early finds like you have, and most get seen by some kind of tumor board of multidisciplinary doctors. Those cancer center environments have an approach which is more comprehensive, and questions like what is the etiology of this ( my teams epidemiologist was involved) are asked and answered. Without knowing the cause, smoking, virus, or perhaps not knowable, part of the questions for the future go unanswered. There have been posters here that have had multiple small surgeries to remove things like yours, and it just keeps coming back. There surgeons just keep cutting them off, but some eventually progress to an oral cancer that can't be dealt with so easily.

Good luck with the removal today. Since you have now had this go all the way from a pre-cancer, to dysplasia that was high grade, to an actual spot of cancer - you need to be vigilant from now until forever that this isn't happening again, and if it does that you catch it at the earliest possible moment.

Cancer that spreads out of the very local environment most often will go to the lymph nodes of the neck as it spreads. So a painless, firm, fixated hard spot in your neck would be a symptom of it leaving. But a MRI or CT scan of your mouth and neck might catch something like that before you could feel or see it. My guess is your doctor thought this was such an early find that checking that area with a scan was unnecessary.