Cancer inside the nose typically appears as an abnormal growth on the nasal lining, ranging from a fleshy, reddish mass to an ulcerated sore that doesn’t heal. Because these tumors grow on internal tissue that you can’t easily see, most people don’t notice them visually. Instead, they’re found during an endoscopy after persistent symptoms like one-sided nosebleeds, nasal blockage, or bloody discharge prompt a visit to a specialist. What the growth looks like depends on the type of cancer involved.
Squamous Cell Carcinoma: The Most Common Type
The majority of cancers in the nasal cavity and paranasal sinuses are squamous cell carcinomas, which form in the thin, flat cells lining the inside of the nose. These tumors tend to appear as irregular, fleshy masses along the nasal walls or septum. The surface often looks raw or ulcerated, sometimes with crusting or areas that bleed easily when touched. A hallmark clue is a non-healing ulcer, one that persists for weeks and may gradually destroy the septum or surrounding bone.
Because these tumors grow on tissue that looks similar to inflamed or irritated nasal lining, they can be mistaken early on for a stubborn infection. The key difference is that squamous cell growths are typically firm, irregular in shape, and confined to one side of the nose. They may also produce bloody or foul-smelling nasal discharge that doesn’t respond to antibiotics or nasal sprays.
Mucosal Melanoma: Dark, Pale, or Somewhere Between
Nasal melanoma is far less common but visually distinctive when pigmented. On endoscopy, it typically appears as a polypoid (mushroom-shaped), one-sided lesion with uneven coloring. The surface can be brown, black, red, or pale white, sometimes with smaller satellite lesions nearby. Unlike skin melanoma, which is usually darkly pigmented, up to 40% of nasal melanomas are amelanotic, meaning they lack dark pigment entirely. These pale or pinkish forms are especially difficult to spot early because they can resemble benign polyps or inflamed tissue.
Around 20% of nasal melanomas are multifocal, appearing as more than one lesion at a time. This scattered growth pattern, combined with the frequent lack of pigmentation, makes these tumors particularly challenging to diagnose without a biopsy.
Olfactory Neuroblastoma: A Glistening Mass High in the Nose
Olfactory neuroblastoma (also called esthesioneuroblastoma) is a rare cancer that starts from nerve cells involved in the sense of smell. It originates in the upper part of the nasal cavity, near the roof of the nose and the thin bone separating the nasal cavity from the brain. On examination, these tumors appear as soft, glistening, reddish-grey polypoid masses. The surface tends to look smooth with intact overlying tissue, and the interior is heavily supplied with blood vessels, giving it a pinkish-red to greyish-tan color when cut.
These tumors can range from under 1 centimeter to large masses that expand into the sinuses, the eye socket, or even through the skull base into the brain cavity. Because they start so high in the nose, they’re rarely visible without an endoscope and often go undetected until they cause loss of smell or one-sided nasal obstruction.
Aggressive Tumors With Rapid Growth
Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, fast-growing cancer first described in 1986. It typically presents as a large, fungating mass with poorly defined borders, meaning it looks like an irregular, outward-growing lump without clear edges where the tumor ends and normal tissue begins. Symptoms tend to progress over just weeks to months, which is unusually fast for nasal tumors. As it expands, it can push the eyeball forward, compress the optic nerve causing vision problems, and invade the skull base.
How Cancerous Growths Differ From Polyps
Nasal polyps are common benign growths, and many people searching for what nasal cancer looks like are really trying to figure out if something they already have could be dangerous. A few visual and clinical differences help separate the two.
- Side of the nose: Benign polyps from chronic sinus inflammation almost always appear on both sides. Polyps or masses associated with tumors usually occur on one side only.
- Bleeding: Benign polyps rarely bleed on their own. Nasal bleeding is common with tumors because cancerous tissue is fragile and richly supplied with blood vessels.
- Surface texture: Polyps tend to be smooth, pale, and translucent, looking somewhat like peeled grapes. Cancerous growths are more likely to appear irregular, firm, ulcerated, or discolored.
- Response to treatment: Polyps often shrink with steroid sprays. A mass that doesn’t respond or continues growing despite treatment raises suspicion for malignancy.
None of these features are definitive on their own. A tissue biopsy is the only way to confirm whether a nasal mass is cancerous.
Symptoms That Point to Something Visible Inside
Most people with nasal cancer don’t discover it by looking. Instead, a combination of symptoms leads to a specialist examination where the growth is seen for the first time. Common early signs include persistent one-sided nasal blockage, recurrent nosebleeds from one nostril, and dirty or blood-tinged nasal drainage. Headaches and facial pressure that don’t improve with typical sinus treatments are also frequent.
As the tumor grows, external changes can become visible from the outside. A lump may develop on the face, the roof of the mouth, or along the bridge of the nose. One eye may begin to protrude or shift position if the tumor invades the orbit. These later signs reflect a cancer that has already expanded well beyond the nasal lining.
How Common These Cancers Are
Sinonasal cancers are rare overall, occurring at a rate of 1 to 2 cases per 100,000 people per year. Men are roughly twice as likely to develop them as women. A large Italian registry tracking over 800 cases between 2008 and 2023 found that the five-year survival rate was 57% after accounting for other causes of death, with about half of all patients dying within five years of diagnosis. Outcomes vary significantly depending on the cancer type and how far it has spread at the time of diagnosis, which is why persistent one-sided nasal symptoms warrant prompt evaluation with an endoscope rather than repeated courses of antibiotics.