A Rare Case of Aggressive Tongue Malignant Melanoma: Clinical Presentation and Treatment Approach

Tongue malignant melanoma is a very rare and highly aggressive subtype of oral mucosal melanoma (OMM), often diagnosed at advanced stages due to its asymptomatic course and rapid progression. This case report describes a 69-year-old female who presented with a progressively enlarging lesion on the ventral surface of her tongue, present for 10 years. Diagnosis of spindle cell malignant melanoma was confirmed by incisional biopsy, and staging revealed right cervical lymph node involvement without distant metastasis. The patient underwent hemiglossectomy, comprehensive neck dissection, and reconstructive surgery, followed by adjuvant radiotherapy (RT) with a simultaneous integrated boost (SIB) delivering 60 Gy to the surgical bed and high-risk lymph nodes and 54 Gy to contralateral low-risk lymphatics. Despite achieving initial local control (LC), aggressive distant metastases, including mediastinal lymph nodes, bilateral lung nodules, and bone lesions, rapidly developed within three months post-RT. Genetic analysis revealed no BRAF mutation, thus limiting targeted therapeutic options. This case underscores the significant diagnostic and therapeutic challenges posed by tongue malignant melanoma, emphasizing its aggressive biological behavior and high metastatic potential. A multidisciplinary approach combining radical surgery and adjuvant RT is crucial; however, the rapid distant progression highlights the critical need for more effective systemic treatment options and the integration of genetic profiling to guide personalized therapies. Further comprehensive research is essential to optimize management strategies and improve the limited survival outcomes associated with this rare and challenging malignancy.