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We describe two patients with acquired tufted angioma, a unique vascular lesion not previously reported in the oral mucosa. In one patient, the lesion manifested as a purple-red papule and, in the other, as a blue submucosal swelling. Both lesions were non-painful and neither was associated with a history of trauma. The histopathological features consisted of scattered, irregularly shaped tufts, primarily composed of poorly formed capillary spaces and slit-like vascular channels. Capillary spaces were often closely packed, producing solid areas which stained for smooth muscle actin. Staining for factor VIII-related antigen was positive only within endothelial cells lining well-formed vascular channels. Both lesions were treated by excision; short-term follow-up of one patient revealed no evidence of recurrence. Similarities between this and other vascular processes may have resulted in misdiagnosis of this lesion in the past. The clinical significance of acquired tufted angioma in the oral mucosa is not known.