Last place in the championship again went to Italy despite taking a 7-0 lead against the Scots in Rome with a stunning piece of brilliance from Ramiro Pez.
The flyhalf deftly chipped the ball ahead with the outside of his left foot for center Mirco Bergamasco to run through, take the catch and score the try.
Paterson replied with a try and contributed 10 points, while flyhalf Gordon Ross' drop goal at Stadio Flaminio also ensured Scotland's first away win in the championship in the last four years.
Scotland coach Frank Hadden, whose team also beat France and England, said he was pleased that his team had gone from perennial losers to potential champions.
"I'm confident where we are," Hadden said. "We have laid some very important foundation stones. We were never going to make dramatic progress in one season. I never thought we would win the championship this year, but we have done enough to make people believe we are a good side."
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