Secondary signs of cancer are difficult to assess in the archaeological context, as other lesions may mimic metastases on dry bones. Furthermore, the low life expectancy, lower level of environmental cancer risk factors and pollution than the present times can contribute in limiting the frequency of signs of cancer in archaeological populations. This study focuses on a female adult skeleton from the necropolis of Bormio (North Italy), dating back to Middle Ages, which shows multiple lytic lesions on cranium, upper limbs, ribs and pelvis; lesions are oval in shape, with a diameter ranging from 1–2 to 80 mm. The lesions appearance and distribution at macroscopic and radiographic level, together with sex and age indications, suggest the diagnosis of metastatic cancer. Possible diagnostic hypotheses of the possible sites of original cancer were performed as well, based on modern epidemiological data. Copyright © 2017 John Wiley & Sons, Ltd.