We present a case of acroangiodermatitis that for nearly 15 years was unrecognized and treated with skin grafting and radiotherapy. This case is also unusual in that neither venous insufficiency nor an underlying arteriovenous malformation could be demonstrated. Acroangiodermatitis is infrequently reported; a review of the literature emphasizes the similarities to Kaposi sarcoma both clinically and histologically. Because treatment for Kapsoi's sarcoma and hemangioendothelioma involves skin grafting and radiotherapy, awareness of this entity by dermatologists, surgeons, and pathologists is important.