Isolated Skull Metastasis as first presentation of possible primary from Lung

Skull or scalp metastasis is commonly seen in carcinoma of breast, prostate, kidneys and lungs. Here we report a case of 80-year-old male who presented with scalp swelling for treatment. High resonance ultrasonography (HRUS) and contrast-enhanced computed tomography (CECT) of brain showed large soft tissue lesion on right occipito-parietal region with erosion of underlying bone, suggestive of neoplastic etiology. Subsequently, on further workup, his CT thorax showed lesion in right hilar and lower lobe of right lung with mediastinal lymph nodes. Patient underwent excision of the right occipito-parietal lesion which on histopathology was reported as epithelial malignancy, favoring metastatic moderately differentiated squamous cell carcinoma. This case is reported here to emphasize the importance of good clinical workup to rule out metastatic lesions which might be the initial presentation of an unknown primary at other site.