Unilateral bloodstained nasal discharge

A man in his 40s presented with six months of bloodstained nasal discharge from his right nostril. Nasal endoscopy showed purulent bloodstained nasal discharge in the right nasal cavity and a mass with an irregular friable appearance in the right middle meatus of the right nasal cavity; the appearance of the septum and left nasal cavity was normal. He underwent a non-contrast computed tomography scan of his sinuses (fig 1). Fig 1 Computed tomography scan of the sinuses shown in the coronal plane Biopsy showed cytoplasmic keratinisation, intercellular bridges, and keratin pearls. What is the most likely diagnosis? Sinonasal squamous cell …