Summary:

Background:
Clinical practice is seeing an increasing number of patients with malignant tumors of the nasal cavity. The aim of this study was to examine trends in the initial diagnosis of nasal cavity carcinomas over a 20-year period and to analyze potential factors contributing to the observed increase.

Methods:
A single-center, retrospective analysis was conducted, identifying all patients with a primary diagnosis of nasal cavity carcinoma between 2005 and 2025. Demographic and histopathological characteristics, tumor location, tumor stage, and the surgical and reconstructive procedures performed were analyzed. Furthermore, trends in annual initial diagnoses were examined and considered in the context of potential demographic and epidemiological influencing factors.

Results:
A total of 237 patients were included. The gender ratio was approximately 2:1 in favor of men, consistent with ratios described in the literature. Histologically, squamous cell carcinomas predominated (71%), followed by adenocarcinomas (5%), olfactory neuroblastomas (4%), and malignant melanomas (4%). Tumor stages did not follow a normal distribution but rather a U-shaped pattern, with a concentration of both early and advanced stages. Based on surgical reports, the tumor originated in the main nasal cavity in 35% of cases and in the region of the nasal vestibule, nasal septum, or nasal roof in 31%.

Regarding treatment, 37% of patients were fitted with a prosthesis, 20% underwent reconstruction using various flap techniques, and 9% received local autologous grafts. 12% of the tumors were resected endoscopically, and another 12% via lateral rhinotomy. Patients treated primarily with radiotherapy (including RCT, IMRT, or brachytherapy) required the fewest subsequent surgeries on average. Patients fitted with prostheses underwent an average of slightly more than two surgeries, whereas up to ten surgical interventions were required for patients undergoing flap reconstruction.

The number of initial diagnoses showed a continuous increase over the study period, averaging approximately 0.5 additional cases per year. A marked, temporary decline in case numbers occurred during the COVID-19 pandemic. The expansion of the catchment area during the years under Prof. Federspil can partially—though not fully—explain this increase. Demographic change—specifically an increase of approximately 6.3 million people in the over-50 age group—is also insufficient as a sole explanation.

Conclusion:
This single-center analysis reveals a marked increase in initial diagnoses of carcinomas of the nasal cavity over the past 20 years. In addition to an expanded catchment area and demographic shifts, other epidemiological factors appear to play a role. Despite declining tobacco use, long-term exposures—particularly to inhaled harmful agents and occupational carcinogens such as hardwood dust—may contribute to the observed trend. Due to long latency periods, preventive measures might only show an effect after a significant time lag. Changes in occupational exposure among women, as well as viral factors (specifically HPV) and genetic alterations, must also be considered as potential contributing factors. However, given the retrospective nature of the data and the lack of testing for some of these factors in certain cases, their actual impact on the study cohort cannot be conclusively assessed.