Expert Strategies: Controversies in Management of Sinonasal Malignancies—Global Perspectives Through a Mixed Methods Approach

Background Sinonasal malignancies (SNMs) are a rare group of diseases with limited high‐level evidence to guide management. Where data are currently lacking, contemporary management principles may be guided by clinical expertise and experience. Methods Structured qualitative thematic interviews with multidisciplinary international experts in the management of SNMs. A mixed‐methods design involving qualitative and quantitative analysis of the collected data was completed. Results A total of 40 experts comprising 22 academic institutions across nine countries were included. Surgical factors, including anatomic limitations of resectability and criteria for consideration of orbital exenteration, are discussed. There are mixed opinions on the role of induction systemic therapy and when to employ its use. Nuances in the management of specific histopathologies, including olfactory neuroblastoma, adenoid cystic carcinoma, sinonasal mucosal melanoma, adenocarcinoma, nasopharyngeal carcinoma, sinonasal undifferentiated carcinoma, squamous cell carcinoma, and rhabdomyosarcoma, are explored. Commonalities and discrepancies between experts are summarized. The importance of histopathology‐specific management and multidisciplinary management is highlighted. Conclusions Management of SNMs is complex, with a wide variety of practice patterns among experts. This work serves as a modern guide for expert management paradigms where little data currently exists.