Malignant neoplasms of the calvarium can be classified into primary or secondary neoplasms. Primary neoplasms originate from the cells of the skull, whereas secondary neoplasms are metastatic manifestations from primary tumors located elsewhere in the body. These tumors are rare as primary bony tumors of the skull only account for 1% of all bony tumors. Clinical signs and symptoms vary for each individual case depending on tumor location. Imaging is useful for confirming the presence and location of tumors, but biopsy is needed to confirm diagnosis. The principles of treatment are similar for many tumors, although every presentation is different and a custom care plan should be developed for every case. The most common primary malignancies of the calvarium include fibrosarcoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma. Secondary malignancies of the calvarium are often from breast cancer, lung cancer, melanoma, prostate cancer, thyroid cancer, renal cell cancer, intrahepatic cholangiocarcinoma, neuroblastoma, or hematologic malignancies. These tumors all present with varying histological and clinical presentations. Obtaining a complete patient history and understanding the characteristics of these different tumors are essential for proper diagnosis, creation of a treatment plan, and improved patient outcomes.