Metastasis to the hand, wrist, radius, or ulna is rare, accounting for approximately 0.1% of all bony metastases. The appearance of hand metastases is a poor prognostic sign. Patients will typically present with pain, swelling, fracture, or concern for infection. Radiographs may demonstrate lytic lesions or extensive bony destruction. MRI provides high sensitivity to evaluate these lesions. The primary goal of surgical intervention is to decrease pain and maintain hand function and stability when indicated. Patients may be deconditioned and unable to tolerate invasive procedures. Surgical treatment may be used to excise the metastatic lesion when indicated. Intralesional procedures as well as wide local excision are options. Reconstruction with allograft, autograft, cementation, or arthrodesis may be needed for bone lesions with concern for instability. Palliative surgical options include amputation. However, these interventions are not without risks, and overall patient prognosis should be considered before proceeding with complex reconstruction.