Cutaneous angiosarcoma of the head and neck is a rare vascular neoplasm. When it does occur, it is most common in elderly white men. Early diagnosis and treatment are essential for local control of this aggressive tumor, but recognition can be delayed because of its rarity or because of difficulty in making a pathologic diagnosis. A combined-modality treatment approach is most often advocated. We report the case of a 77-year-old black man who presented with a 1-month history of two painless, violaceous, subcentimeter nodules of the upper lip. After a diagnosis of low-grade angiosarcoma was definitively established, the lesions were locally excised with good cosmetic and functional results. The patient subsequently was found to have probable metastatic disease, but he declined further intervention. We review the literature on cutaneous angiosarcoma, and we discuss its epidemiology, presentation, tissue diagnosis, treatment, and prognosis in an effort to increase awareness of this rare malignancy.