In order to examine the role of left perisylvian cortex in spelling, 13 individuals with lesions in this area were administered a comprehensive spelling battery. Their spelling of regular words, irregular words, and nonwords was compared with that of individuals with extrasylvian damage involving left inferior temporo-occipital cortex and normal controls. Perisylvian patients demonstrated a lexicality effect, with nonwords spelled worse than real words. This pattern contrasts with the deficit in irregular word spelling, or regularity effect, observed in extrasylvian patients. These findings confirm that damage to left perisylvian cortex results in impaired phonological processing required for sublexical spelling. Further, degraded phonological input to orthographic selection typically results in additional deficits in real word spelling.