Squamous cell carcinoma is the most common malignancy affecting the sinonasal tract. Local recurrence is the main pattern of treatment failure, affecting nearly half of patients treated for primary sinonasal squamous cell carcinoma (SNSCC). Due to disease rarity and heterogeneity of practices, there are limited guidelines for how to diagnose and care for these patients. This paper reviews current evidence regarding etiology, pathophysiology, diagnosis, prognostic factors, and treatment modalities of recurrent SNSCC (rSNSCC). Currently, salvage surgery offers the only durable approach for eligible patients. These resections often require robust reconstructive options due to prior surgery or radiation. Chemoradiation is offered as an adjuvant or palliative approach when surgery is not a feasible option. Emerging options such as immunotherapy and particle therapy remain an area of ongoing investigation.