Perineural Invasion of the Facial Nerve Presenting as Rapid-Onset Excruciating Facial Pain and Paralysis

This case emphasizes the need for thorough evaluation of atypical facial paralysis, particularly in elderly patients with a history of cutaneous malignancy. The presence of facial pain, progressive hearing loss, and imaging abnormalities should prompt consideration of perineural tumor spread. Early recognition and multidisciplinary management are critical for timely intervention and improved palliative care outcomes.