Metastases to the hand are rare. The incidence of secondary tumors in the hand is about 0.15%. The lung, breast, and kidneys are the most common sites of primary lesions that metastasize to the hand. The authors report about a 66-year-old female who showed an osteolytic metastatic lesion in the os pisiforme which was ulcerated on the ulnopalmar aspect of the right wrist, 18 months after radical cystectomy because of a bladder carcinoma. In agreement with the patient, as well as with colleagues from the pathological, oncological, and radiotherapeutical field, the hand was not amputated as this was a solitary metastatic lesion.