A case report of a rare proximal phalanx metastasis from a primary lung carcinoma is described. The presenting symptom of the patient was pain in the proximal phalanx of the index finger. Radiographs at the time of presentation were unremarkable, and no diagnosis was provided. Because of increasing pain and eventual swelling, the patient presented for emergency assessment. Radiographs, less than 3 months after initial assessment, demonstrated a large lytic lesion within the proximal phalanx. Biopsy of the lesion documented a large cell malignancy consistent with a poorly differentiated adenocarcinoma. Subsequent investigations documented an occult lung neoplasm. The patient underwent palliative ray resection followed by the initiation of palliative chemotherapy for the primary carcinoma. A brief review of literature regarding acrometastases is provided and the potential benefit of early positron emission tomography scanning is discussed.