What is the most appropriate initial step for a unilateral nasal mass in an adult?

• A. Endoscopic evaluation with biopsy to rule out malignancy; refer to ENT
• B. CT scan first
• C. Observation for several weeks
• D. Empiric antibiotics

Answer: (A)

Unilateral nasal mass in an adult demands tissue diagnosis because it carries a significant risk of malignancy or other serious pathology. The best initial step is endoscopic evaluation with biopsy to obtain a tissue sample for pathology and to assess the lesion directly. This approach provides definitive information to guide management and the need for ENT involvement. Imaging, such as a CT scan, is important for planning after diagnosis or if endoscopy is inconclusive, but you should obtain tissue first rather than assume a benign cause. Observation or empiric antibiotics miss the opportunity to diagnose a potential cancer and delay appropriate care.