Sinonasal malignancies are highly heterogeneous lesions that are challenging to diagnose, treat, and follow clinically. Outcomes remain relatively poor and are associated with late diagnosis, difficult surgical anatomy, and a lack of effective adjuvant modalities of treatment. New multimodal treatment protocols addressed to specific tumor entities are being assessed with promising results. Because of the relative rarity of these lesions, however, progress is slow. The best therapeutic outcomes are achieved in the setting of early diagnosis combined with a meticulous, comprehensive, multidisciplinary approach to the management of these complex tumors.