Skin metastases from colorectal cancer are a rare phenomenon that occurs only in 4,4% of cases. The presence of a cutaneous lesion at the Romatime of diagnosis is even more uncommon (0,05% of cases), and represents a sign of widespread, poor prognosis and terminal disease. Skin involvement by colorectal cancer can occur in four different pathways: lymphatic, hematogenous, direct invasion of contiguous tissues or iatrogenic implantation. We describe a case of a 68-year-old patient affected by a pT4b pN1 M1 sigma carcinoma with a head lesion that, at the time of diagnosis, mimics a lipoma at the head CT scan.