Introduction: Malignant Peripheral Nerve Sheath Tumour (MPNST) is a malignant tumour arising from a peripheral nerve or showing a nerve sheath differentiation, with the exception of tumours originating from the epineurium or the peripheral nerve vasculature. Most of these tumours arise on the trunk, extremities, or head and neck regions. MPNST of the scalp is very rare. Case Report: We, report the case of a 71-year-old woman with a lesion in the scalp over the occipital region with FNAC showing the features of MPNST. Wide local excision and split skin grafting were done. Histopathological analysis of the resected specimen strongly supported the diagnosis of MPNST. The patient received adjuvant radiotherapy and was disease-free for 2 years and later presented with bone metastasis. Discussion: MPNSTs are rare soft tissue tumours that arise in proximity to large peripheral nerves and account for 3-10% of all soft tissue sarcomas. Primary MPNST of the scalp is extremely rare and very few cases have been reported in the literature. In this report, we have described the clinical and pathological characteristics of this rare tumour. We have also discussed the various treatment options offered. Conclusion: Scalp MPNSTs are aggressive lesions, and multimodality approaches including surgery and adjuvant radiation are necessary to optimize outcomes. Every attempt should be made to obtain wide and negative margins since positive margins are significantly associated with a poor outcome.