A 60-year-old woman developed an avascular leiomyoma arising from a digital artery in the thumb and was successfully treated by en bloc excision. Leiomyomas in the hand are very rare, and thus the diagnosis will seldom be made on clinical evaluation. They may be more painful than other common, benign tumors, however, and may originate from a digital artery. Preoperative evaluation of vascular function may give a clue to the presence of a leiomyoma. A spectrum of vascular smooth-muscle tumors from very vascular to relatively avascular is noteworthy.