Intravascular large B-cell lymphoma (IVLBCL) frequently presents with cutaneous and central nervous system manifestations in patients from Western hemisphere. The skin lesions consist of erythematous or violaceous subcutaneous nodules or plaques with or without hemorrhage and ulceration on the trunk or extremities. The patients may also develop petechiae, purpura, ecchymoses, telangiectases or cellulitis. This skin biopsy is from an elderly female who presented with purplish skin nodule on her leg, clinically thought to be a hemangioma. The small and medium-sized blood vessels throughout the dermis and subcutaneous tissue demonstrated tumor cells that were positive for CD45 and CD20 immunostains and negative for epithelial and melanoma markers.