Frontal sinus malignancies comprise 2% to 3% of those occurring in the paranasal region. Patients commonly present with forehead pain and swelling, orbital disturbances, epistaxis, and nasal purulence. A combination of CT and MR imaging delineate the tumor and its relationship with the adjacent dura and periorbita. Low-grade malignancies are addressed with en bloc extirpation, with lower frontal sinus and adjacent ethmoid lesions approached through a superior rhinotomy, and more extensive lesions through a combination of a bicoronal flap and rhinotomy. Postoperative irradiation is appropriate for medium- to high-grade lesions. Small to medium defects are closed with local rotation flaps and larger defects with free flaps. Bony reconstruction can range from a split calvarial bone graft to mini plates and wire mesh.