Verrucous carcinoma is a low-grade variant of squamous cell carcinoma reported to occur in all anatomic sites in the head and neck region, most commonly the oral cavity. The tumor grows locally invasive but is histologically benign and metastasizes rarely. To date, 22 cases of verrucous carcinoma involving the nasal cavity and/or the paranasal sinuses have been reported. We present a case of verrucous carcinoma involving the paranasal sinuses, nasal cavity, cranium, and orbit. This case highlights the difficulty of pathologic diagnosis and management options for a rare neoplastic lesion.