Nodular melanoma is an aggressive subtype of malignant melanoma, accounting for a disproportionate number of melanoma-related deaths due to its rapid progression and early metastatic potential. Despite its distinct histopathological characteristics, clinical diagnosis can be challenging, particularly when the presentation mimics other conditions. We present the case of a 67-year-old male whose facial nodular melanoma was initially treated as an invasive fungal infection due to overlapping clinical and radiographic features, including osseous destruction, soft tissue invasion, and systemic involvement. The patient underwent antifungal therapy, which resulted in acute kidney injury from amphotericin B, prior to a definitive diagnosis by histopathological analysis. This case highlights the importance of maintaining a broad differential diagnosis for atypical facial lesions, especially those with aggressive features or poor response to initial therapies. Early biopsy and tissue evaluation are essential to distinguish malignant melanoma from infectious or inflammatory conditions and to ensure timely, appropriate management.
Keywords: facial melanoma; invasive fungal mimic; nodular melanoma; soft tissue mass; sox10 positive tumor.
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