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Preauricular masses are commonly seen in the otology clinic. Excisional biopsy is essential for diagnosis, and treatment is necessary to reduce the risk of malignancy and for cosmetic purposes. We recently treated a rare case of angioleiomyoma of the preauricular area. Angioleiomyoma is a benign tumor arising from smooth muscle within blood vessel walls. These tumors can arise anywhere in the body; however, they are usually found in the lower extremities and present as a painful mass. Angioleiomyoma of the preauricular area in an elderly person is rare, and only a few cases have been reported. Here, we report the case of an 85-year-old male patient with angioleiomyoma of the preauricular area and provide a literature review.