A Rare and Alarming Cancer on the Tongue: What a New Case Reveals About Oral Melanoma
Why This Case Matters
Melanoma is widely recognized as a skin cancer—but it can also appear in places we rarely check, like inside the mouth. A new case report published in Cancer Reports highlights a particularly rare and aggressive form: malignant melanoma of the tongue, a cancer that accounts for less than 2% of oronasal melanomas.
This new case is striking not only because of where the cancer appeared, but because it returned even after initial successful treatment—offering important lessons for clinicians and the public about vigilance, early detection, and the challenges of treating mucosal melanoma.
Understanding Oral Melanoma: A Silent and Dangerous Disease
A Rare Subtype of Melanoma
Oral mucosal melanoma (OMM) is a very uncommon form of melanoma that affects the lining of the mouth. Unlike skin melanoma, it is not linked to sun exposure. The tongue is one of the least common sites for this cancer, making the condition especially hard to diagnose early.
Because symptoms can be subtle—sometimes just a pigmented spot that doesn’t cause pain—many patients are diagnosed at late stages, when the disease has already become aggressive.
Why Early Detection Is Difficult
OMM can look similar to harmless pigmented lesions, such as oral nevi or post-inflammatory pigmentation. It can also appear without any pigment, which further complicates diagnosis. Many people rarely inspect their oral cavity closely, causing concerning lesions to go unnoticed.
This makes clinical evaluation and biopsy essential whenever a suspicious oral lesion is found.
What the Researchers Studied
The article presents the case of a 33-year-old woman from Tehran who previously underwent surgery to remove melanoma from her tongue. Despite a successful first operation and two years of routine follow-up, a new lesion emerged in the same area.
This recurrence prompted further investigation, leading the medical team to explore:
How tongue melanoma behaves
The effectiveness of repeat surgery
The potential role of adjuvant therapies like radiotherapy
How resource limitations influence treatment decisions (e.g., limited access to targeted therapies)
The report combines the patient’s clinical journey with a thorough review of existing literature on oral melanoma, filling gaps in the limited global knowledge of this rare disease.
What Happened in This Case?
Initial Diagnosis and Treatment
The patient first presented with a small pigmented, ulcerated lesion on her tongue. Tests confirmed malignant melanoma. She underwent:
Partial glossectomy (surgical removal of part of the tongue)
Reconstruction of the defect
Imatinib therapy, due to positive c-KIT mutation
No radiotherapy (patient declined)
She remained cancer-free for two years.
Recurrence and Second Treatment
In 2021, a new dark spot appeared on her tongue. Biopsy confirmed a recurrent melanoma, now thicker (8 mm) but still without evidence of spread to the lymph nodes or distant organs.
Given access limitations to systemic therapies, the tumor board recommended:
Repeat partial glossectomy, confirming clear surgical margins
Reconstruction using a submental flap
Adjuvant radiotherapy (60 Gy in 30 sessions)
Long-Term Outcome
Follow-up over three years revealed no new recurrence, showing that aggressive local treatment can offer meaningful disease control—even for recurrent oral melanoma.
What This Case Teaches Us
1. Oral Melanoma Can Recur Even After “Successful” Treatment
The report highlights the importance of lifelong follow-up, especially because mucosal melanoma has a high recurrence rate.
2. Early Diagnosis Is Critical—but Challenging
Non-pigmented or subtle oral lesions can disguise danger. Clinicians should maintain high suspicion for any persistent oral lesions.
3. Surgery Remains the Mainstay of Treatment
Even with modern cancer therapies, surgical removal with clean margins continues to be the most effective approach—especially when access to targeted drugs is limited.
4. Multimodal Therapy May Improve Outcomes
Adding radiotherapy or immunotherapy can support local control, although mucosal melanoma is generally resistant to radiation.
Conclusion
This rare case of recurrent tongue melanoma emphasizes the need for:
Careful monitoring of oral lesions
Early biopsy to avoid late diagnosis
A multidisciplinary approach combining surgery, radiotherapy, and—when possible—targeted therapy or immunotherapy
Long-term follow-up due to the high risk of recurrence
By documenting this clinical experience, the report adds important knowledge to a field where evidence is still scarce—and offers hope that even aggressive oral melanomas can be managed effectively through timely intervention and coordinated care.
Original Article Reference
Motiee-Langroudi, M., Farahzadi, A., & Aminshakib, P. (2025). Recurrent Malignant Melanoma on the Tongue: A Case Report and Review of the Literature. Cancer Reports, 8:e70215.
DOI: 10.1002/cnr2.70215