Sinonasal malignancies account for only 3% of all cancers of the head and neck and typically affect Caucasian males who are 50 to 70 years of age. This report identifies a number of risk and environmental factors that have been linked with the development of such malignancies, the clinical presentation of these tumors, clues to the diagnosis, and the pathology of the most commonly encountered types. Treatment of sinonasal malignancies is controversial and depends largely on the type of tumor encountered. The authors describe surgical and chemotherapeutic modalities, used alone and in combination. The controversy surrounding the utility of radiotherapy before or after surgery is also discussed.