Osseous metastases to the hand and wrist are uncommon. Most cases represent the manifestation of known malignancy with disseminated disease. Less commonly, acrometastases are the initial presentation of malignancy. In both instances, diagnosis of malignancy is frequently not considered either clinically or radiographically. This results in a delay in diagnosis and in inappropriate therapy. Three cases of occult malignancy presenting as acrometastases are reported. The author stresses the importance of considering this diagnosis when faced with any aggressive lytic or blastic lesion of the hand and wrist in a patient in the fifth decade of life or older.