In May 2018, an immunocompetent 65-year-old man with no familial history of skin cancer was recovered due to a large ulceration involving the proximal portion of the right leg causing hypofunctionality of the limb and osteomyelitis with loss of neuronal substance. A cutaneous biopsy demonstrated an SCC. The ulceration was too large to be subjected to local excision; therefore, after a complete radiological staging with chest and abdomen computed tomography that did not show distant metastases, amputation of the middle third of the right leg was made. The definitive histological examination showed an ulcerated area of 13 cm, necrotic, haemorrhagic, incorporating and full-thickness infiltrating from skin to the underlying bone tissue, compatible with poorly differentiated SCC. For persistence of secretions, the wound was revised and cleaned several times. One month after amputation, a radiological restaging with chest and abdomen computed tomography showed multiple bilateral lung lesions compatible with distant metastases and a dubious intracardiac nodularity. The patient was then studied for a possible infectious disease but all the exams (including tuberculosis screening) were negative. We performed a fibrobronchoscopy with biopsy of a mediastinal lymph node and bronchioloalveolar lavage, resulting in positive SCC in both samples. The following positron emission tomography highlighted multiple lung localisations (Standardised uptake value 20), widespread skeletal accumulation referable to osteomidullary activity compatible with substitutive meaning and a left and right atrial nodularity compatible with metastases (standardised uptake value 7, 4). Echocardiography revealed a solid lesion on the atrial side of the anterior tricuspid flap; the ejection fraction determined to be 85%. A transesophageal echocardiography documented in the right atrium a voluminous tripartite formation with a sessile spherical base of 3 cm in diameter and two other non-homogeneous mobile formations of 2 and 5 cm in diameter, each comes into contact with the atrial margin of the tricuspid valve. In the left atrium, evidence of a roundish 2 cm diameter formation anchored by a peduncle to the atrial roof was compatible with metastases (Figures 1-5). A cardiac surgery consultation determined that the extent of the disease, including at the pulmonary level, suggested that surgical intervention was inappropriate. A cardiac nuclear magnetic resonance was unsuccessful since the patient experienced rapid dyspnoea that arose from lying in a supine position. Despite the extent of the disease and the cardiac involvement, considering the young age of the patient and the conserved cardiac function, we proposed a platinum-based chemotherapeutic treatment; however, when informed of the possible risks and benefits of the treatment, the patient preferred not to undertake any oncological treatment.