We describe an interesting case of a 62-year-old white female who presented to our clinic with a vascular malformation of her tongue that had been clinically apparent for approximately 30 years. The area had been surgically excised twice, with recurrence following both procedures; however, surgical treatment was limited owing to fear of potential functional impairment. After obtaining magnetic resonance imaging of the affected area, the patient was treated with one session of transmucosal Nd:YAG laser. The affected area appeared to resolve almost immediately following treatment. The patient had continued resolution at her 5-month follow-up visit and at 18 months by telephone follow-up. This case illustrates an excellent outcome from transmucosal treatment of a vascular malformation of the tongue with Nd:YAG laser. We discuss the various available treatment modalities for vascular malformations of the tongue as well as the risks and benefits of each. We also present a recent review of the literature pertaining to Nd:YAG laser treatment of these lesions.