Cup and ring marks are also common in the Fertile Crescent and India, and later in the Mediterranean, Atlantic, and Alpine regions of Europe, sometimes associated with complex petroglyphs or megalithic monuments.

Some of the earliest cupules can be found at the Bhimbetka cave site in India, dating to 290,000-700,000 BCE, but in Europe they do not pre-date the most recent cold phase (the Würm or Weichselian glaciation).

Very large specimens weighing several tons and with dozens of impressions several inches across are thought to be cult objects; they have been found throughout the Mississippi Valley.

"[6] In Hawaii, cup and ring marks are associated with petroglyphs, and those occurring in the boundary regions of Apuki and Puna lands have been used as depositories for a child's navel cord, a custom also observed in other Polynesian peoples.

Indeed, the apparent randomness of their distribution may indicate that they were left lying as modified natural resources, whether with benevolent intent or because they did not represent a sufficient investment of time and labor to justify transporting them ("opportunistic" tools).

While an equivalent to "pitted stone", the proposed term has the advantage of wider comprehensibility among international scholars as the worldwide distribution of the form becomes increasingly evident.

Cupstone sites in Northern Italy, Switzerland and the Atlantic regions, also known as "druid altars" or "Opferkessel" (sacrificial bowl), are associated with places of worship due their locality close to glacial erratics, view points and treacherous alpine trails.

Some of the prehistoric cupstone sites north of the Alps along the Jura mountains, for example near Grenchen, show a row of cups with possibly astronomical orientation.