Skull metastases of primary hepatocellular carcinoma are very rare, even in the Orient and the Africa where this carcinoma is one of the common rnalignancies. However, although these skull tnetastases are rare, this diagnosis must be considered when an skull tutnor has a metastatic appearance, especially in cirrhotic patients or heavy alcoholics. This lesion is extremely hypervas- cular, and precautions for hemorrhage must be taken before any procedure, even a biopsy is done. The prognosis remains lethal and average survival time after the time of diagnosis is under 6 months, but appropriate local surgical resection to the skull region and systemic control with chemotheraphy and radiotheraphy can result in improved survival. The patient reported here may be valuable in presenting an unusual occurance of primary hepatocellular carcinoma with metastases to the skull. (Korean J Gastroenterol 1996; 28:415 - 420)