Introduction <p>Oral squamous cell carcinoma (OSCC) poses a significant global public health challenge, accounting for more than 90% of oral malignancies. With an estimated global incidence of 300,000 new cases annually, OSCC exhibits high morbidity and mortality rates, particularly in South and Southeast Asia, where betel nut chewing is common. This case highlights the role of betel nut consumption as an independent risk factor for OSCC, even in the absence of tobacco or alcohol use, in the United States, where betel nut chewing is not a common practice.</p> Case presentation <p>A 55-year-old male presented with a rapidly progressing nodular, ulcerative lesion on the right lateral border of his tongue, a frequent site for OSCC. The patient reported habitual betel nut use but no history of tobacco or alcohol consumption. Clinical examination revealed a large lesion on the anterior two-thirds of the tongue, raising suspicion of malignancy. Histopathological evaluation confirmed a diagnosis of moderately differentiated squamous cell carcinoma (G2). The patient underwent subtotal glossectomy, bilateral neck dissection, and a reconstructive surgical procedure. A tracheostomy was performed for airway management. Postoperative histopathology confirmed complete tumour excision.</p> Conclusions <p>This case underscores the importance of early detection and multidisciplinary management in OSCC. It emphasizes the need for public health strategies to address betel nut use, even in regions where its consumption is uncommon, to improve access to care for at-risk individuals. Recognizing OSCC in non-endemic populations and developing targeted interventions are essential in reducing the global burden of OSCC.</p>