Case report 
A 33 years old woman presented to our clinic with a pigmented mass with ulceration in the left posterolateral part of her tongue that was gradually growing five months before her presentation. There was a 1 cm pigmented ulcerated mass with a satellite smaller discoloration adjacent to it without palpable cervical lymphadenopathy on physical exam. An incisional biopsy was taken that turned out to be malignant melanoma. MRI showed an enhancing lesion measuring about 14 mm ×6 mm at the posterolateral part of the tongue without cervical lymphadenopathy. There was no evidence of distant metastasis in chest abdominopelvic CT scan. The patient has no history of smoking or alcohol use. Medical history was noncontributory. Partial glossectomy with safe margins was performed, and the defect was reconstructed with a local flap. Pathology revealed malignant melanoma with satellite lesions with a maximum thickness of 5-6 mm. Striated muscles were infiltrated by tumors. Lymphovascular invasion was present. There was evidence of macroscopic and microscopic satellite nodules. All surgical margins were free.  She refused postoperative radiotherapy but was under maintenance imatinibR treatment due to the strong positivity of C-KIT.
On her regular follow up there was no evidence of recurrence for about two years. Then after, she noticed a black spot on her tongue that gradually increased in size without any accompanying symptoms. Physical examination revealed a 15 mm×10 mm pigmented mass at the left posterolateral portion of her tongue, it was indurated and non-tender without ulceration. There were no other similar lesions intraorally or elsewhere on her body. MRI of the neck revealed an enhancing lesion measuring about 14.6 mm at the left posterolateral portion of the tongue related to the patient’s known pathology.  Incisional biopsy of the lesion revealed malignant mucosal melanoma. PET scan and neck ultrasonography revealed no evidence of distant metastasis or local lymphadenopathy. Her condition was discussed at the multidisciplinary tumor board, and she became a candidate for surgery and adjuvant radiotherapy. Therefore, she underwent a partial glossectomy. Fig1. The frozen section confirmed tumor margins were free of malignant cells and the defect reconstructed with a submental flap. Her post-op course was uneventful. The pathology report revealed T3N0 malignant melanoma with safe margins. Fig2. Maximum tumor thickness was 8 mm, ulceration was present, microsatellite lesion was not identified, there was no evidence of lymphovascular invasion nor neurotropism. Mitotic rate was 4 mitoses per mm2. Adjuvant Radiotherapy started about one month after surgery. She is currently undergoing regular follow-up. No local recurrence of the lesion was found during the 3-month follow-up period.