Introduction Mucosal melanoma of the head and neck is a rare and aggressive malignancy associated with delayed diagnosis and poor prognosis. Oropharyngeal involvement is uncommon and may be asymptomatic or detected incidentally, creating diagnostic and management challenges. Methods A case of incidentally detected oropharyngeal mucosal melanoma is presented, alongside a focused review of the literature examining patterns of presentation, staging strategies, and current surgical management principles for mucosal melanoma of the upper aerodigestive tract. Case and Results A middle-aged male was referred with an incidentally identified pigmented lesion of the uvula. The lesion was asymptomatic and not associated with cervical lymphadenopathy. Histopathological analysis confirmed mucosal melanoma. Staging investigations demonstrated no evidence of regional or distant metastatic disease. Following multidisciplinary discussion, the patient underwent wide local excision, with subsequent re-excision required to achieve clear margins. Postoperative recovery was uncomplicated. Early surveillance imaging demonstrated no evidence of local recurrence or metastatic disease. Discussion The literature demonstrates that oropharyngeal mucosal melanomas are frequently diagnosed at an advanced stage due to their occult location and lack of early symptoms. Complete surgical excision with clear margins remains the cornerstone of treatment, although margin width is often limited by anatomic and functional constraints. The role of elective neck dissection and adjuvant therapy remains uncertain, reinforcing the need for individualised, multidisciplinary decision-making. Conclusion Incidental detection of oropharyngeal mucosal melanoma can permit timely surgical management and favourable early outcomes. Vigilant head and neck examination and evidence-informed multidisciplinary care are essential in managing these rare tumours.