The temporal bone is a composite structure consisting of the tympanic bone, mastoid process, squama (also known as the squamous portion of the temporal bone), and petrosa (also known as the petrous portion of the temporal bone). Although the styloid process is closely related to the temporal bone, it is not considered a portion of it.It contains the structures of the middle ear and inner ear. Also it is related to vital structures as the temporal lobe and the internal carotid artery. According to different histological structures in the temporal bone there are many tumors could arise either from external auditory canal or the middle ear. Carcinomas as squamous cell carcinoma, basal cell carcinoma, malignant melanoma and adenexal carcinomas. Sarcomas as angiosarcoma, chondrosarcoma and rhabdomyosarcoma. Each type has its own behavior and presentation. Malignant tumors of temporal bone could spread directly to involve surrounding tissues as parotid gland anteriorly through fissures of santorini. Superiorly to involve temporal lobe, deeply to involve middle ear structures facial nerve and inner ear reaching to the internal carotid and petrous apex. In general, temporal bone malignancy has low incidence of lymphatic and distant metastasis but if present it carries very poor prognosis.Age incidence in temporal bone malignancies usually above 60 years except in case of rhabdomyosarcoma that present in younger age groups.The presentation is usually in the form of bloody otorhea, hearing loss or aural polyp.On examination we can see suspicious granulations that bleed on touch or tumor mass itself.For accurate diagnosis of temporal bone malignancies biopsy must be taken from the suspicious polyp or tumor mass. Also computed tomography and magnetic resonance imaging play very important rule in tumor staging to know extensions of the tumor if vital structures as internal carotid artery is affected or not. Also MRI is superior on CT in diagnosing soft tissue involvement and perinural spread of tumors. Magnetic resonance angiography can be done also to detect carotid and big vessel affection. Recently fusion between CT and MRI is used for better visualization of temporal bone tumors.Management of malignant tumors of temporal bone could be through surgery, radiotherapy or a combination of both.The role of chemotherapy is generally limited and it is beneficial only in case of rhabdomyosarcoma. It is used also for palliation to control distant metastasis.The treatment program depends primarily on the extent of the cancer. Cancer limited to the EAC (T1, T2) should be treated by lateral temporal bone resection with superficial parotidectomy and preservation of the facial nerve. Rarely, the cancer may be small, isolated in the lateral cartilaginous aspect of the EAC, and not eroding bone, thereby permitting sleeve resection of the external canal skin, lateral to the tympanic membrane. In practice, sleeve resection is probably not oncologically adequate.Cancer that has invaded the middle ear and mastoid cavities (T3) is treated by subtotal temporal bone resection. Total temporal bone resection (sometimes called Radical temporal bone resection) is performed when cancer extends to the petrous apex. Cancer extending to the temporomandibular joint (TMJ), neck, dura, or Infratemporal fossa (T4) will require resection of these structures.Radiotherapy is essential in the treatment of temporal bone malignancy especially if combined with surgery for adequate local control of the disease. It improves the prognosis of large lesions, in case of positive margins and in recurrence after surgery.Stereotactic radiosurgery is used for treatment of limited tumors not more than 5 cm. It represents a new non invasive line of treatment with decreased morbidity.It is difficult to determine adequate outcome of treatment of temporal bone malignancy for several reasons. Temporal bone malignancy is so rare that no one center has extensive experience with treatment. Lack of universally accepted staging systems and the wide variety of treatment protocols applied make comparison of results difficult. Generally, undifferentiated tumors give poor prognosis. The survival rate will be affected according to the type and invasion of the tumor to the surrounding structures. Recurrence after surgery and radiotherapy gives very bad prognosis.