There's a real danger that gore hounds will approach Phantom of Death (Un Delitto poco commune, aka Off Balance) with expectations of content that the film was ever destined to meet. One of the first titles put out on DVD by new horror label Shameless, released alongside the notoriously violent New York Ripper, it was directed by Ruggero Deodato, the man responsible for that prince of video nasties, Cannibal Holocaust. Phantom of Death has its gory moments, including an early smash-through-glass murder that has giallo splattered all over it, but it later reveals itself to be an altogether different beast. And a rather good one.

Heading up the characters is handsome 30-something concert pianist Robert Dominici, and as we listen to him hammering the ivories, a woman is violently murdered by an unseen assailant. Is there a connection? Could be. Following his concert, centre-of-attraction Robert floats around a garden party until grabbed by Susanna, a girl he's been casually dating who now wants to get serious. But the idea of marriage and kids doesn't appeal much to our Robert. He has a thing for the ladies nonetheless, and a short while later is being chatted up by the beautiful Helene, something he doesn't try all that hard to resist.

Also at the party is the cheerless inspector Datti and his breezy daughter Gloria. Datti missed the concert because he was investigating the murder and has nothing to go on but vague witness description of a 30-year-old man seen leaving the scene. Susanna, meanwhile, is busy getting over her disappointment at Robert by sleeping with his best friend David. All this has taught her is that she'd rather be with Robert, so she hops out of bed and heads straight back to his place, pausing only to phone him and tell him she's on the way and to promise never to talk about marriage again. She's just leaving the train station when she's killed with extreme violence, and the paths of Inspector Datti and Robert Dominici begin their film-long intersection. Datti talks to Robert and interrogates David and gets absolutely nowhere, but the case becomes a bit personal when the murderer phones Datti at home to taunt him and obliquely suggest that Gloria might be a future target.

By this point director Deodato has started playing a curiously schizophrenic game with the audience, hiding the killer's identity in shadow and yet repeatedly pointing us at the increasingly troubled Robert. A suggestive edit here, a not so well disguised voice there, it all points to a cinematic frame-up to steer us away from the real suspect. And yet he keeps on doing it, and with no-one else in the frame it soon becomes clear that Robert may well be our man after all.

It's once we're sure of this that things get interesting. There's clearly something wrong with Robert beyond his grief for Susanna (a grief that drove him almost straight to Helene's bed and then off to Venice to visit his mum). His hair starts falling out, and when one poor fool makes light of it in a garage washroom, Robert flies into a fury and batters him senseless. Gradually, his appearance begins to deteriorate – his skin wrinkles and discolours, his posture stoops and his teeth begin to rot. In a matter of months, Robert has the look of a tired and middle-aged man. Before this really kicks in he's given a preview of his own future when he spies on a child suffering the same, super-rare medical condition, his young body topped by the head of an old man. All he does is sit on a swing, hold a ball and look at the camera, but I swear this is one of the creepiest scenes I've sat through all year.

By the halfway point, the guessing games are over on all fronts. We know who the killer is and Datti knows who the killer is, he just can't prove it and the evidence is frustratingly contradictory. It's from here on the the audience division could set in. If you came for the blood then you're out of luck, but if your taste runs to psychological drama then this could be your day. As Robert's condition continues to crumble, he sets an intriguing cat-and-mouse game with Datti in motion. The centrepiece is a standout sequence in which Robert does everything but offer himself up for capture, but by way of his changing appearance always stays one step ahead of his chosen nemesis.

It's surprisingly involving stuff, and this you can chalk up to three things: Ruggero Deodato is a far better director than his video-nasty reputation misleadingly suggests (the editing is sometimes particularly impressive); the crucial ageing makeup is pretty damned good; and Robert and Datti are played not by a pair of badly dubbed matinee idols but Michael York and Donald Pleasance respectively. Each is allowed to ham it up a bit in places – York with the anguish, Pleasance with the anger – but elsewhere both do well by their characters. Pleasance has the tired and frustrated cop down to a tee, and once he's embedded in make-up, York really gets his teeth into the role of crumbling crazy man without, for the most part, overplaying it.

The parallels with Phantom of the Opera are occasionally obvious, but at his most bent up and lispy, York reminded me irresistibly of Jeff Goldblum in the latter stages of his mutation in David Cronenberg's The Fly. Indeed, there are enough similarities to suggest a direct influence, particularly in Robert's later musings to the pregnant Helene and the sadness for his character that dominates the final scenes. I'm not suggesting by this comparison that Phantom of Death climbs the same dramatic or artistic heights as Cronenberg's film, because it doesn't. But it deserves recognition beyond its probable pigeonholing as an Italian genre cheapie – for Pleasance, for York, for its plotting and make-up, and for that bloody kid on the swing.

For some inexplicable reason I wasn't expecting an anamorphic widescreen transfer here but that's what we have. There's a slight softness to the picture and some of the detail is lost to shadow, but in other respects this is a decent enough job. The black levels are certainly solid and the print is clean. Played on my computer's DVD drive there was some noticeable blocking on the picture, but there's no sign of this on my TV, so I'm blaming that on the playback software.

The mono 2.0 soundtrack is in slightly less impressive condition. Particularly noticeable is some stuttering background fluff that is occasionally quite pronounced. That aside, it's a damage-free track with an inevitably limited range.

As with New York Ripper, the only extra feature is the Original Trailer (3:07), which is not shy about showing the violence – by my count every killing in the film is included.

Also included are trailers for a splash of upcoming Shameless releases, which can be accessed from the main menu. They also play before the main feature, and it has been pointed out to me by our good editor (who did not work this out himself, I should add) that this pre-feature placement is a deliberate and nostalgic throwback to the original VHS releases. He's right, of course, something I'll qualify by saying I enjoyed each and every one of them (I'm practically slobbering at the thought of finally seeing the notorious Killer Nun). You can also bypass them should you wish to by simply pressing 'menu' on the remote. Missed that one too.

While we're on the nostalgia trip, I should give a mention to the on-disc copyright notice, something most of us ignore to grab a beer from the fridge before the movie starts. The one here really is worth a look. Amusingly executed in the manner of an old TV with a bad connection, it rounds off the usual warnings with the suggestion that you live a happy and fulfilling life and love your neighbour, all set to some fluffily upbeat 'interval' music. The final "or else..." cheerfully recalls the old VHS videos from Palace, which contained a similarly amusing warning.

Quite a bit about Phantom of Death surprised me, not least the fact that I liked it as much as I did. The audience may well to be a narrow one and the gore hounds are likely to be a bit pissed off at a climax that's all about tragedy and emotion rather than violence, but horror fans should still give it a chance – they might just enjoy it.