Most common presentation of neuroblastoma is –
Lytic lesion in skull with suture diasthesis
Lung metastasis
Renal invasion
Secondaries in brain
Most frequent site of metastasis from neuroblastoma is bone : where metastasis occurs very early.
Lytic lesions in skull and sutural diastasis are manifestations of bony metastasis to skull, and hence the earliest feature, amongst the options in the questions.