This paper presents one case from Kerma (ind-14.1.595 or K317) which was initially reported to have a ‘fatal traumatic wound’ in the front of the skull. The individual has a dime sized, circular hole with no radiating or concentric fracture lines associated with it. It also shows clear evidence of healing along the inside edges of the pathology. This was according to the preliminary, and only, analysis performed when excavated at Kerma (1913–1916), which was most likely performed by a crew member not formerly trained in anthropology, or medical science. Differential diagnosis will be discussed with respect to this lesion actually being a form of traumatic injury, possible remnants of a bony tumour, and trephination, among other diagnoses. Trephination has been identified in ancient Egypt and Nubian studies, though it is a rarity. Although trephination is a possible cause for the present lesion, this example does not fit the morphology of any other examples of the practise from this region or time period. Given that there have been similar borings witnessed on architecture from the Egyptian Old Kingdom, this lesion may suggest implementation of an already present architectural tool for medical purposes among the Kerma Nubians. Copyright © 2011 John Wiley & Sons, Ltd.