Metastasis of hepatocellular carcinoma (HCC) in the nasal septum is an extremely rare condition. The proper management and the role of surgical intervention are still controversial and there is no evidence-based guideline for this specific condition. The authors of the present study report a case of HCC with sinonasal metastasis, managed by surgery to relieve nasal obstruction and frequent epistaxis. Complete removal of the tumor via endoscopic surgery was performed and the pathology was reported to be consistent with metastatic HCC. No additional treatment modality was considered for the septal lesion. During the 8-month postoperative period, the patient remained alive and satisfied with comfortable nasal breathing. The present case report stresses the importance of interdisciplinary collaboration. Proper consultation between surgeon and oncologist may lead to improved quality of life, even when the patient is in the terminal stage of HCC.