<p>Squamous cell carcinoma of the base of the tongue is a prevalent condition that significantly contributes to the global burden of morbidity and mortality, especially in Western countries. Often patients present with a suspicious lesion in the base of tongue, where a conventional surgical biopsy is either ineffective or cannot be performed without first warranting a tracheostomy or requiring general anaesthesia. There is limited data on the feasibility of performing ultrasound-guided transcutaneous biopsies of the base of the tongue. In this case report, we performed an ultrasound-guided biopsy of a tongue base lesion extending posteriorly up to the pyriform sinus with restricted mouth opening, bypassing the need for a tracheostomy and general anesthesia to diagnose malignancy of the oropharynx.</p>