More than one half of cancer patients are likely to develop bone metastasis; thus, most orthopaedic surgeons will be presented with an adult patient with a destructive bone lesion. Proper management requires comprehensive patient evaluation, including history, physical examination, laboratory studies, and radiographic staging. Biopsy should be done in the patient with a possible malignant or metastatic tumor. The differential diagnosis of destructive bone lesions in patients aged >40 years includes metastatic bone disease, multiple myeloma, lymphoma, and, less commonly, primary bone tumors. Inaccurate diagnosis and improper treatment may adversely affect limb or life. Adherence to oncologic principles during the evaluation process aids in minimizing a negative outcome.

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