Leiomyosarcoma of the scrotum is a rare tumor. Cutaneous and subcutaneous leiomyosarcomas constitute the two subtypes. We report a case of cutaneous leiomyosarcoma of the scrotum in a 73-year-old man. Cutaneous leiomyosarcoma arises from the smooth muscle of the dartos or arrectores pilorum. It is often mistaken for a benign lesion. We describe the clinical and pathologic features and review the published reports of this uncommon malignancy. It is best treated by wide local excision. Inguinal lymph node dissection is not advocated, unless a high degree of suspicion is present for lymph node metastasis. Long-term follow-up is essential, because of the risk of delayed local recurrence and distant metastasis.