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Carcinoma ex pleomorphic adenoma (Ca ex PA) is a rare malignant tumor of salivary glands that originates in a primary (de novo) or recurrent pleomorphic adenoma. In the carcinoma component of Ca ex PA, many histological subtypes have been identified. It is difficult to make the diagnosis of this tumor because it has various histological findings. A case of Ca ex PA involving a very elderly woman's soft palate is reported. A 92-year-old woman visited our hospital with a chief complaint of a soft palatal mass. The mass was suspected to be a pleomorphic adenoma based on the clinical and magnetic resonance imaging findings. The tumor was diagnosed as Ca ex PA after the surgical procedure. The histological subtype of the malignant component was adenocarcinoma not otherwise specified (NOS). Although she had many indicators of a poor prognosis, no additional therapy was performed because of her age. It was reported that accurate diagnosis and surgical management of patients presenting with Ca ex PA could increase their survival rates. The management of Ca ex PA in very elderly people should be explored, taking into account their age, physical status, and risks.