Acrometastases are defined as metastatic lesions sited distally to the elbow or knee.A 45-year-old man sought consultation at this health center in May/2025. Background: Alcohol-induced cardiomyopathy; Atrial fibrillation; COPD; Former drinker and smoker (85,5 pack-years); Two episodes of pneumonia in the previous year. While awaiting a public cardiology consultation, he had irregular follow-ups with a private cardiologist and a pneumologist. He presented with swelling of the left thumb that had started two months prior. He denied pain. An X-ray requested by a private orthopedist showed a lytic lesion at the base of the distal phalanx – the radiologist suggested an ultrasound. Meanwhile, during his first cardiology consultation in the public system, a coronary CT angiography (CCTA) was requested. Three weeks later, he came back with the result of the ultrasound: Bone tumor with defined margins involving the distal end of the proximal phalanx and most of the distal phalanx. A CT scan and an orthopedic oncology consultation were requested. One month later, he returned to renew his sick leave. At this appointment, he presented two new facial skin nodules that resembled keratoacanthomas, prompting a dermatology referral. Later that day, he went to the ER due to hemoptysis. The CCTA he had done showed extracardiac findings; consequently, a chest CT scan was performed – it revealed a hypodense left hilar lesion. He was hospitalized, and a bronchofibroscopy with biopsy confirmed the malignant etiology of the lesion (epidermoid carcinoma). The face and finger lesions were biopsied and turned out to be metastases. He’s currently undergoing immunotherapy and chemotherapy.Acrometastases are rare.This case made us aware of an unusual presentation of lung cancer.This patient had a major risk factor for lung cancer – high tobacco load. Although rare, acrometastases are frequently linked to this type of cancer and are associated with a grim prognosis. They can mimic various conditions, leading to misdiagnosis and treatment delays, hence the need for a high index of suspicion.Family doctors should be aware that distal extremity lesions can represent metastatic disease, especially in high-risk patients.