Skin cancer is the most common cancer in Ireland. Our patient presented for removal of a cutaneous lesion on his ear. The histopathological diagnosis was malignant epithelioid hemangioendothelioma. It is very rare for this to present primarily as a cutaneous lesion. Here, we discuss the management of this patient and the surveillance he required. It is important to consider alternative histological diagnoses in patients presenting with cutaneous lesions and how this affects management and prognosis.