An adult has unilateral obstruction, blood-stained discharge and new diplopia. Endoscopy shows a friable nasal mass; CT demonstrates bone erosion. What is the best next management principle?
A unilateral destructive sinonasal lesion with orbital symptoms is malignant until proven otherwise. Tissue diagnosis and imaging must be coordinated so that biopsy route and timing do not compromise definitive treatment.
A. Treat as uncomplicated chronic rhinosinusitis: Unilateral bleeding, erosion and orbital symptoms are red flags.
B. Perform repeated office cautery: This does not establish diagnosis and may obscure anatomy.
C. Start topical steroids and review in six months: Delay may permit orbital or intracranial progression.
D. Undertake definitive resection before staging: Extent and pathology guide the appropriate oncological operation.
E. Urgent specialist staging with planned biopsy that preserves future surgical options: A unilateral destructive sinonasal lesion with orbital symptoms is malignant until proven otherwise. Tissue diagnosis and imaging must be coordinated so that biopsy route and timing do not compromise definitive treatment.
If biopsy showed an inflammatory condition such as GPA, immunological and medical management would replace cancer surgery planning.
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