Primary chest wall tumors consist of 5% of all thoracic tumors and 0.04% of all primary tumors. Almost half of primary chest wall tumors are benign. Over half are metastases from distant malignancies or direct invasions from adjacent malignancies such as breast cancer, lung cancer, mesothelioma and mediastinal tumor. Chest wall mass can form from trauma and infection. So it is important to take a medical history including past trauma and infection. Past history of cancer and radiation is also important. While diagnostic imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) is valuable in determining boundary of tumor and detecting invasion to the nerves and vessels, biopsy should be performed to confirm diagnosis. Then the strategy for each patient with chest wall tumor should be planed according to the results of preoperative examinations. For high grade malignancy, such as osteosarcoma and Ewing sarcoma, multidisciplinary treatment including chemotherapy should be considered. For an unresectable case or patient with inadequate margin at previous chest wall resection, radiation should be considered. Radio-sensitive neoplasm such as desmoid tumor responds well to radiation. Wide resection of malignant chest wall tumor is the treatment of choice. Although a 2-cm surgical margin may be adequate for chest wall metastasis, benign chest wall tumor and chondrosarcoma, malignant chest wall tumor undergo wide resection to include a 4-cm margin. Selection of chest wall reconstruction for each patient is also important to prevent postoperative complication.