Focal choroidal excavation (FCE) represents a macular choroidal concavity. It is categorized as conforming and nonconforming, and may be associated with complications such as choroidal neovascularization. The purpose of this report is to present a rare case of FCE and choroidal neovascularization in a 33-year-old male patient without history of other pachychoroid spectrum disorders, who showed spontaneous transition from a nonconforming to a conforming form. To our knowledge, this is the first report in the literature describing this unexpected clinical course in a patient with FCE without central serous chorioretinopathy.