Head and neck malignancies follow a predictable pattern of metastatic spread. A case of recurrent Nasal Cavity SCC with Breast metastasis is reviewed. Few other case reports in the literature have been identified. A PET avid left breast lesion was identified on imaging following development of nasal cavity recurrence three years post initial resection. Diagnostic workup by the Breast service culminated in lumpectomy. Histology examination revealed SCC with morphology and immunohistochemistry consistent with initial nasal primary. Additionally, we review the literature on oligometastatic Head and Neck SCC and discuss alternative therapies and prognostication.