Because of its prominent location on the face, the nose is the primary target for sun-induced skin cancers. The unique anatomical features of the nose account for the unusually high rate of recurrence of tumors at this site. The reasons are multifactorial and have been discussed. Special care must be undertaken in managing cutaneous neoplasms arising in this region, for failure to control disease can lead to catastrophic events and eventually to the demise of the patient. Likewise, tumor recurrence and multiple therapeutic endeavors are associated with progressive facial deformity that impacts significantly on the patient's self-image and ability to interact socially. Reconstruction of nasal defects must be predicated on complete tumor ablation and documented by histologic evidence. Patients with high-risk lesions or in whom tumor margins are in question should undergo a period of observation before definitive reconstruction is contemplated. Although multiple reconstructive options are available, decisions relating to timing, advisability, and appropriate technique must be individualized. These judgments are based on the experience and bias of the surgeon as well as the goals and concerns of the patient.