Aim:This study aimed to assess trends in the incidence, clinical stage, and risk factors associated with tongue cancer in young patients (aged <50 years) over a ten-year period at a tertiary head and neck referral centre. Methodology:A retrospective cohort study was conducted using data from the Head and Neck Departmental database, to identify tongue squamous cell carcinoma (SCC) diagnoses in patients under 50 years of age. Patients were divided into two periods: 2015–2019 and 2020–2025. Patient demographics and risk factors, clinical stage, subsite, and recurrence rates were analysed. Results: A total of 300 tongue SCC cases were identified, of which 39 occurred in patients <50 years. Tongue cancer case numbers increased significantly year-on-year over the study period (Z = 2.47, p = 0.014), while the proportion of patients <50 years remained stable (OR 0.93, 95% CI 0.84–1.04). Median age was similar between cohorts (39.5 vs 37.4 years) and there were no significant differences in gender distribution, alcohol use or smoking status (all p > 0.05). Although the proportion of advanced-stage tumours (Stage III–IV) increased from 45.5% to 67.9%, this difference did not reach statistical significance (p = 0.20). Tumour subsite analysis showed a significant rise in posterior tongue cancers from 9% to 39% between periods. While this difference approached statistical significance, confidence intervals were wide reflecting limited sample size. Trends toward higher nodal positivity (4/11 vs 20/28, p = 0.06) were observed, while locoregional recurrence rates remained similar (p = 0.60). Conclusion: This ten-year institutional review demonstrates a significant increase in overall tongue SCC case burden in recent years. Although the proportion of young patients has remained stable, concerning trends toward posterior tumour location, nodal involvement, and advanced stage at presentation were observed. These findings highlight the need for ongoing surveillance and improved strategies for earlier detection.