A patient with a malignant epithelioid hemangioendothelioma that presented as an aneurysm of the superficial palmar arch and third common digital artery had complete excision of the aneurysm and vascular reanastomosis. After pathologic diagnosis and surgical staging she received local irradiation to the hand. This case suggests that an aneurysm in the hand may develop in the setting of an underlying malignancy of blood vessel. When aneurysms in the hand require surgical intervention, we recommend that resection be complete, pathologic examination undertaken, and marginal tissue well-labeled to allow precise pathologic examination. Copyright (C) 2002 by the American Society for Surgery of the Hand.