Background <p>Cutaneous metastasis (CM) is an uncommon manifestation of internal malignancies, with nasopharyngeal carcinoma (NPC) as an exceptionally rare primary source. NPC, a subtype of head and neck carcinoma, demonstrates geographic variability and aggressive behavior, including potential for distant metastasis. Despite the rarity of cutaneous dissemination from NPC, accurate diagnosis requires comprehensive clinical evaluation supported by histopathological and immunohistochemical assessment.</p> Case presentation <p>A 59-year-old male with previously treated non-keratinizing squamous cell carcinoma of the nasopharynx presented with multiple erythematous papules and nodules in the right axillary region over three weeks. Histopathological examination revealed dense dermal infiltration by atypical epithelial cells arranged in nests. Immunohistochemical analysis demonstrated tumor cell reactivity for pan cytokeratin (CK), CK5/6, and CK7, with a high Ki-67 proliferation index of approximately 75%. These findings confirmed a diagnosis of CM secondary to NPC. Following histopathological confirmation, the patient continued multidisciplinary management under general medical care.</p> Conclusions <p>This case highlights that NPC may present with CM, even years after initial treatment. Early recognition of cutaneous lesions in patients with a history of malignancies is critical, as definitive diagnosis relies on integrative evaluation combining clinical history, morphological assessment, and molecular pathological analysis. Accurate identification of CM directly impacts therapeutic strategies and prognostic evaluation, emphasizing the importance of maintaining high diagnostic suspicion for cutaneous metastasis in at-risk patient populations.</p>