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Sclerotherapy is a common and effective treatment for venous diseases, including venous malformations (VMs), which are common vascular anomalies in the oral and maxillofacial regions. However, the safety of sclerotherapy has not been fully elucidated. Occasionally, patients who underwent sclerotherapy may present diverse but minor side effects such as erythema, swelling, pain, tenderness, hyperpigmentation, skin ulceration and necrosis. Here we report a unique case of a 65-year-old female patient presented with an original VM lesion on the right side of the tongue. Intralesional sclerotherapy and followed surgical resection resulted in major remission of the original lesion, without recurrence during a 3-year follow-up. However, two years later, the patient was again referred to us for a painful mass on the right side of the tongue that gradually enlarged for 1 month. The mass was biopsied under local anesthesia after complete systematic examination, and the result indicated a well-differentiated squamous cell carcinoma (SCC). Then, the patient underwent right neck dissection, extensive resection of the SCC, reconstruction of the defect with forearm flap, microvascular anastomosis, and repair of the forearm defect with free abdomen skin graft. To the best of our knowledge, this is the first study to document the development of oral SCC after sclerotherapy for VM, underscoring the need for long-term follow-up. The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1897394831087742 .