Leiomyosarcoma is a malignant smooth muscle abnormality that I only rarely encounter in both my The Woodlands dermatology and Conroe dermatology offices. A Leiomyosarcoma may arise in the dermis, second layer of skin, as a solitary nodule. These dermal Leiomyoscarcomas can originate from the arrector pili muscles surrounding hairs or the dartos muscle in the genitals. The dermal Leiomyosarcomas have a better prognosis than the deeper subcutaneous Leiomyosarcomas. Lung metastasis is common in Leiomyosarcomas so chest imaging is very important in the oncologic monitoring. Treatment of Leiomyosarcomas is wide local excision and oncologic workup and evaluation.