There is a wide variety of nasal sinus malignancies, also including malignant melanoma from the mucosa of the nasal sinuses. These tumors are known as the kings of cancer and are extremely malignant and highly susceptible to distant metastases. In the past, malignant tumors occurring in the nasal sinus region often required removal of the maxilla, alveoli, and orbits, causing significant damage to the face. However, in recent years, patients are increasingly interested in preserving their orbits, eyes, jaws, and alveoli, as they are increasingly interested in postoperative quality of life and a dignified life after returning to society. We use endoscopic techniques in the surgery of nasal sinus malignant tumors. With the cooperation of image navigation and intraoperative pathological detection, we use endoscopic techniques to remove complex nasal sinus malignant tumors while trying to protect important organs and structures of the patient’s head and face, such as the orbits and eyeballs, using a clear view of the endoscope to remove lesions including the orbits, orbital walls, skull base, and lacrimal apparatus, and then send the tumor margins to pathological sections. The tumor margins were then sent to pathology to check for residual tumor. Every effort was made to achieve a final cut margin free of tumor. For those tumors that could not be removed due to their extreme proximity to important structures, we marked them one by one, and postoperatively, in collaboration with oncologic radiologists, adjuvant radiotherapy was administered. In this way, the patient’s facial destruction was avoided and the eye was preserved. The case, female, 54 years old, was found to have right-sided nasal congestion and bleeding for 2 months to the local hospital, and the pathology was reported as malignant melanoma, and she came to our office. After careful examination of the condition, we found that the tumor was located in the right maxillary sinus and was widely invasive, compressing the orbit, invading the alveolus and part of the bone had been compressed and absorbed. Preoperative PETCT did not show any distant metastasis, but showed a large tumor that partially protruded into the pterygopalatine fossa and inferior temporal fossa, as shown in Figure 1. Since the patient could not accept the removal of the orbit and the alveolus, we decided to perform transnasal endoscopic resection of the nasal sinus tumor. The lateral wall of the nasal cavity, the tumor, the orbital wall and part of the hard palate and the alveolus were removed surgically. Multiple pathologies were taken intraoperatively to determine whether we had completely removed the tumor and to identify where the tumor remained. In the end, the tumor was completely removed and the orbital and facial features were preserved. As shown in Figure 3. Postoperatively, adjuvant radiotherapy was performed in close consultation with the radiotherapy department. The patient has been followed up for 1.5 years with no local recurrence or distant metastasis.