Superficial leiomyosarcoma has an incidence of less than 3% of the cutaneous soft-tissue sarcomas, and 1% to 5% of the tumors occur on the face. Because of its rarity and unusual location, preoperative misdiagnosis is common. An 82-year-old woman visited with a preauricular huge and hemorrhagic mass. The mass developed 4 months ago and showed rapid progression. First impressions of the tumor were squamous cell carcinoma and keratoacanthoma. However, the biopsy indicated a high degree of suspicion of leiomyosarcoma. On the metastasis workup, there was no metastatic lesion. The patient underwent a wide excision with 3-cm margin, and the raw surface was covered with split-thickness skin graft. All resection margins were free of tumor, and the stage was IA according to the American Joint Committee on Cancer grading system. The skin graft was well taken, and the patient is well with no evidence of disease recurrence or metastasis after 18 months.