The unique morphology of the human scalp and skull provides a fertile ground for a variety of pathologies to evolve at any age. Generally, most scalp and cranial vault lesions are fortunately benign or are of little concern. However, some lesions are more worrying, especially when red flag symptoms/signs are present such as rapid growth of a mass, neurologic deficits, infectious symptoms, or a lesion discovered in the context of a known history of malignancy. In the literature, there are multiple temptations to establish a classification system for scalp and cranial vault lesions. However, it is not always easy to categorize them. An inventory of the most common scalp and calvarial lesions and pseudo-lesions encountered in neurosurgical practice is given in this chapter according to the anatomic locations and origins of the lesions.