The patient, a 53-year-old woman with T2N2Mx oropharyngeal squamous cell carcinoma, had been recently treated with concurrent chemotherapy and radiation. Shortly after completing this therapy, she was found to have biopsy-confirmed adrenal gland metastasis of the squamous cell carcinoma. Concomitantly, the index finger of her left hand became swollen and painful. Physical examination revealed swelling, erythema, and tenderness of the middle phalanx of the left index finger (A). Acute gouty arthritis was suspected, and she was prescribed prednisone by her general practitioner, without improvement. Radiography of the left index finger revealed osteolytic destruction of the middle phalanx (B). Fine-needle aspiration and cytologic analysis (C) demonstrated single and clustered atypical cells, partly necrotic (Giemsa stained; original magnification × 400). Additional immunohistochemical staining (D) confirmed metastasis of the squamous cell carcinoma (p63 stained; original magnification × 400) compatible with digital acrometastasis of the oropharyngeal cancer. Metastatic malignancies of the hand are rare and usually develop from lung, kidney, or breast tumors. Acrometastasis generally accompanies widespread disease, and therefore the prognosis is poor. Due to poor performance status of the patient, only best supportive care was given, without antitumor therapy.