Introduction. When examining the osteological collection, which came from the excavations of the Natukhaevskoye 5 mediaeval burial ground in the Krasnodar Region, the skeleton of a young man was found from a ground burial of the 14th century. The purpose of the study was to consider, within the framework of differential diagnosis, the possible cause of pathological changes found on this skeleton. Materials and methods. Identification and description of the state of preservation of the skeletal remains were carried out in accordance with the standards for adult and juvenile osteology. Pathologically altered bone fragments were studied using microfocus radiography. Results. The preservation of the bones is fragmentary; there are large and small fragments of the cranial vault and different parts of the skeleton of male, 16-20 years old. Indicators of physiological stress (multiple enamel hypoplasia, Cribra orbitalia) and consequences of systemic pathology were identified. Visual and radiographic examination of the cranial vault revealed through and non-through defects up to 5 mm in diameter with both rounded and uneven edges. Most lytic damages were observed on the frontal bone and on a fragment of the parietal. The radiograph shows that the formation of foci of destruction is associated with the development of a network of small and large blood vessels. In the diaphysis of large tubular bones, hypertrophied development of the spongy substance is observed. Discussion. The most common paleo-oncological diagnoses are metastatic carcinoma and multiple myeloma, in this case unlikely due to the young age of the individual and the morphological pattern of the defect margins. In paleopathology, there are known cases of lymphocytic leukemia with a peak in children aged 2–5 years. Conclusion. Multiple lesions of the skull bones testify in favor of the diagnosis of metastatic cancer in a young man buried in the Natukhaevskoye-5 burial ground. Although the poor preservation of the remains prevents a more accurate diagnosis, there is evidence to suggest a hematogenous cause of oncology.