Tongue Squamous Cell Carcinoma in a Young Patient Without Classical Risk Factors: A Case Report and Literature Review

Squamous cell carcinoma of the tongue usually affects older patients with established risk factors such as tobacco and alcohol use. Its occurrence in very young patients without classical risk factors remains clinically challenging and may lead to diagnostic delay. We report the case of a 20-year-old male patient with no history of tobacco or alcohol use who presented with a three-month history of lingual swelling, dysphagia, right-sided otalgia, marked weight loss, and deterioration of general condition. Clinical examination revealed a firm right submandibular lymphadenopathy and an ulcerative-exophytic, indurated lesion of the right lateral border of the tongue, associated with reduced tongue mobility. Magnetic resonance imaging showed a necrotic tongue mass crossing the midline, with right jugulocarotid lymph node involvement. Biopsy confirmed a moderately differentiated, keratinizing, infiltrative squamous cell carcinoma. Positron emission tomography (PET) imaging showed no distant metastatic disease. The tumor was considered locally advanced, and the patient received multimodal oncologic treatment. Despite an initial partial response, the patient died during follow-up. This case highlights the need for early biopsy and heightened diagnostic vigilance when faced with any persistent lingual lesion, even in young patients without tobacco or alcohol exposure.