Solitary Skull Metastasis as Initial Presentation of Hepatocellular Carcinoma: A Rare Case Report and Management Review.

Hepatocellular carcinoma (HCC) rarely metastasizes to the skull, often leading to diagnostic challenges. This case report describes a 64-year-old man presenting with right-sided limb weakness and a scalp mass in the left parietal region. Initial surgery for the scalp swelling was performed without a diagnostic workup, and the lesion recurred with neurological impairment. Imaging revealed a skull lesion eroding the bone and extending intracranially, with a solitary liver lesion identified as the primary tumour. Surgical resection of the skull metastasis was performed, followed by chemotherapy. Histopathology confirmed high-grade HCC metastasis. The patient showed neurological improvement postoperatively. This report highlights the importance of considering skull metastasis in HCC patients presenting with scalp masses and neurological deficits, especially in endemic areas. Early imaging and aggressive multidisciplinary management, including en bloc resection, can improve outcomes despite the aggressive nature of HCC.