BACKGROUND: Metastatic cancer to the hand is rare with only a few cases having ever been reported. In this case, the diagnosis of lung cancer was unknown until the patient presented with symptoms of a small finger felon. PATIENT HISTORY: A 65 year-old male presented with a prior history of penetrating injury to the distal left small finger for which his primary care physician had treated him with a course of oral antibiotics. Initial examination revealed swelling, erythema and local tenderness. Incision and drainage was performed. At follow-up three weeks later, the patient was found to have a large fungating tumor originating from his left small finger. A biopsy of the mass demonstrated squamous cell carcinoma of bronchogenic origin. CONCLUSION: Metastatic carcinoma to the hand masquerading as a felon can lead to a delay in diagnosis and inappropriate surgical intervention if it is the initial presentation of the primary tumor. For this reason, the hand surgeon should be alert to the possibility of metastatic disease in the atypical presentation of a felon.