Inverted papilloma (SIP) is a relatively rare benign epithelial tumor of the nasal cavity which characterized by an aggressive course with local destruction of surrounding structures, a tendency to recurrence and associated with malignancy. Etiology remains little understood. SIPs is most commonly associated with human papillomavirus (HPV) and mutations in the epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) genes, which are upregulated in recurrent SIPs.These factors are responsible for theinverted papilloma transformation into squamous cell carcinoma (SCC). Prognosis of sinonasal SCC is poor, in most cases likely owing to its advanced stage at presentation. Treatment includes complete SIP removal by endoscopic approach with histological examination. Follow-up of these patients is critical to diagnosing relapse, which can be either early or late. It is important to diagnose recurrence to enable early treatment, especially in case of associated carcinoma or malignancy. In case of SCC, additional radiotherapy and/or neoadjuvant chemotherapy is needed, because it shows promising results in improving outcomes. In this article, we present a clinical case of managing a patient with malignancy of inverted papilloma, which led to extensive destruction.