Cutaneous angiosarcoma is a rare and aggressive malignancy originating from endothelial cells lining blood vessels in the skin. The authors present a comprehensive case report of cutaneous angiosarcoma with infiltration of the scalp and skull, with an abnormal presentation highlighting the clinical features, diagnostic challenges, treatment and surgical strategies, and outcomes. The case underscores the complexity of managing this aggressive disease involving critical anatomical structures and emphasizes the need for a multidisciplinary approach to optimal patient care.