Background: Primary extracranial meningiomas are rare neoplasms that may arise without intracranial or dural involvement and are frequently misdiagnosed as benign scalp lesions. Lack of routine histopathological evaluation of excised scalp masses may delay diagnosis of rare tumors. Case Presentation: We report a 28-year-old woman with a recurrent left parieto-occipital scalp mass associated with positional headache and intermittent vertigo. She had undergone prior excision of a similar lesion five months earlier without histopathological examination and was lost to follow-up. Examination revealed a firm, mobile subcutaneous mass. Contrast-enhanced magnetic resonance imaging demonstrated a well-circumscribed extracranial lesion without intracranial extension or dural attachment. The patient underwent complete en bloc excision. Intraoperatively, the lesion was highly vascular. Histopathology confirmed a World Health Organization Grade I meningothelial meningioma with epithelial membrane antigen and progesterone receptor positivity and a low Ki-67 index (~2%). At one-year follow-up, the patient remained recurrence-free with complete symptom resolution. Conclusion: This case highlights a diagnostic pitfall in which the omission of histopathological evaluation following initial excision led to the delayed diagnosis of a primary extracranial scalp meningioma. It emphasizes that imaging alone is insufficient to exclude rare neoplasms and underscores the need for routine pathological examination of all excised scalp lesions to prevent misdiagnosis and recurrence.